Sexual violence may be defined as sexual activity used with the purpose of manifesting aggression or causing physical harm or psychological damage to the subject of the attack. Rape is a particular type of sexual violence: a penetrative sexual assault. The term “mass rape” refers to the military strategy of widespread, systematic sexual violence and rape perpetrated intentionally against civilian women. In this analysis, living women who have been raped are referred to as survivors, while those who died are referred to as victims.
The UN Commission on Human Rights issued a document on the former Yugoslavia in which rape is classified as “an abuse of power and control in which the rapist seeks to humiliate, shame, embarrass, degrade, and terrify the victim (Falcon, 2001, p. 31). It identified the “exercise power and control over another person” as the primary objective of rape (Falcon, 2001, p. 31).
In the act of rape, the “perpetrator’s sexuality is not an end;” sexuality is an instrument to inflict damage through “sexual means” (Seifert, 1994). Some have argued that “rape is not an aggressive expression of sexuality, but a sexual expression of aggression… it is a manifestation of anger, violence, and domination of a woman. The purpose is to humiliate, degrade, and subjugate” (Seifert, 1994). Support for this assertion includes the fact that the physical violence associated with rape often far exceeds the level necessary to complete the sexual act and that rapists speak of the experience as an aggressive act of dominance, associated with power, rather than particularly sexual act (Heise, 1998). Rape may be used to regulate power relations between genders or between groups (Seifert, 1994).
It has been largely agreed that rape is an act of domination, yet “the violence of rape is peculiarly sexual” and differs contextually from a purely physical assault (Cahill, 2001, p. 27). The sexual nature of the violence may increase the impact of rape because of the cultural and social context, or personal and situational factors, in which the rape occurs and is understood (Cahill, 2001). While men can be raped, this work focuses on the experience of women raped during war as part of a strategy of cultural control.
SCOPE OF THE PROBLEM
It is difficult to quantify the prevalence of mass rape, or to determine with any validity the number impacted by sexual violence in these conflicts, because these women are war’s forgotten victims. Rape is still a stigmatized topic, so it is seriously underreported due to numerous practical and social factors. It is challenging to obtain an accurate census of any kind during a conflict or in active combat zones, and collecting data about sexual violence is wrought with difficulties. Regardless of this complexity, estimates show that scope of the problem of mass rape is appalling, especially considering the fact that most estimates do not account for the complete total. There may be many more survivors and victims than the world will ever know.
Modern war and genocide campaigns utilize mass rape as a strategy to leave vast numbers of severely traumatized victims in their wake (Parin, 1994; Turshen, 2000). Sexual violence and rape were present during WWI and prevalent during WWII. The Nazis are reported to have branded some women with the inscription “Whore for Hitler’s troops,” and it was common for persecuted women to be raped or sexually assaulted in concentration camps and elsewhere (Heise, 1998). The Tokyo Tribunal stated that the Japanese Army raped 20,000-80,000 women during the “Rape of Nanking” in 1937, and enslaved 100,000-200,000 “comfort women” who were forcibly imprisoned and raped to serve the soldier’s sexual needs during the war (Chang, 1997, p. 6). Soviet soldiers reportedly raped more than 2 million German women during the final stages of WWII, and hospital statistics indicate between 95,000 and 130,000 women were raped in Berlin alone. Other modern conflicts have featured mass rape, but it is difficult to obtain credible statistics documenting these atrocities. One well-documented crisis of mass rape occurred in Bangledesh in 1971: it is reported that 200,000 women were raped during conflicts that erupted that year (Heise, 1998).
An estimated 25,000 to 50,000 women were systematically raped during the Balkan Wars of the 1990s; it had been reported that up to 20,000 of these women were forcibly impregnated, and more than 5,000 “bad memory babies” were abandoned on hillsides or killed in the aftermath (Boose, 2002, p. 71; Hardy, 2001, p. 4). The 1994 Rwandan genocide left an estimated 250,000 to 500,000 rape survivors in a single summer, with more than 2,500 infants born the following spring and abandoned (Human Rights Watch, HRW, 1996). This continues to be a pressing issue as mass rape and genocide have recently been reported in the Darfur region of the Sudan by reputable organizations such as Human Rights Watch, Amnesty International and UNICEF (ICRC, 2005; OXFAM, 2006; PHR, 2006; UNICEF, 2006, 2007). It is unknown how many women may be at risk for experiencing mass rape, but these estimates reveal that the problem of mass rape impacts modern women at an alarming scale.
SEXUAL VIOLENCE AGAINST WOMEN:
AN ECOLOGICAL FRAMEWORK
Rape does not have constant functions over time and in all societies, because sexual violence is highly contextualized by individual, situational, social and cultural factors. It is important to contextualize the meaning and function of rape in terms of these social and cultural realities, as well as individual and situational factors that mediate the meaning and function of sexual violence. (Seifert, 1994). A nested, ecological framework of violence against women conceptualizes rape as a multi-faceted phenomenon grounded in an interplay among personal, situational, and sociocultural factors (Heise, 1998).
This ecological framework was developed from findings from a variety of fields, from research relating to all types of physical and sexual abuse of women (Heise, 1998). Because there is little consensus on the etiology of violence against women, it is important to build a model which can contain several explanations and levels of interaction and meaning (Heise, 1998). Only recently have theorists begun to conclude that a complete understanding of gender abuse may require acknowledging factors operating on multiple levels, and this framework encourages “a more integrated approach to theory regarding gender-based abuse” (Heise, 1998). A nested framework allows researchers to “grapple with real life,” by incorporating various perspectives and featuring multiple levels of meaning in the analysis (Heise, 1998, p. 285).
Embedded levels of causality are essential to the ecological framework of sexual violence against women (Heise, 1998, see Figure 1). Heise (1998) describes four levels of influence: individual/ontogenic factors, microsystem/situational factors, exosystem/social structure factors, and macrosystem/cultural factors. The ecological framework applied to the etiology and the consequences of sexual violence against women focuses on the salience of factors at a variety of levels of the social ecology, while attending to the combined influence and interplay between these factors. Acknowledging the influence of situational factors or personal history in no way exculpates the perpetrators of violence, nor does it reduce the salience of macro level factors, such as cultural notions of masculinity and male dominance over women. An comprehensive analysis of sexual violence must recognize the primacy of culturally constructed messages about masculinity/femininity and gender/power roles, while also accounting for social, situational, and individual factors (Heise, 1998).
Ontogenic factors are those features of an individual’s history, developmental experience, or personality that shape the way they respond to microsystem and exostsyem stressors, as well as macrosystem messages that they experience (Heise, 1998). Individual factors such as childhood experiences of abuse or violence, witnessing violence, and previous trauma have been associated with later sexual violence (as victims and perpetrators). Individual factors, such as upbringing, family of origin, genetics, previous experience, and other factors have been linked to resilience and posttraumatic stress.
Microsystem factors include interactions that the individual experiences and the subjective meanings ascribed to these interactions. The most salient microcosm or microsystem factor is usually the family unit, and the structure of the immediate family’s roles and interactions. It has been shown that some family structures may be more likely to produce perpetrators of violence against women. For example, family values of patriarchy and male dominance were shown to have a linear relationship with physical abuse of women (Heise, 1998). When applied to violence, the concept of the microsystem can be best described as the “immediate context of the abuse,” and situational or social factors surrounding the abuse (Heise, 1998).
Exosystem factors can be described as the formal and informal social structures that “impinge on the immediate settings in which a person is found and thereby influence, delimit or determine what goes on there” (Belsky, 1980, p. 321). Some exosystem factors have been linked to violence against women, such as poverty, low socioeconomic status, unemployment, and isolation of women and families (Belsky, 1980). Delinquent peer associations have impacts at the exosystem (social structure) and the microsystem (situational) level. It has been shown that males with sexually aggressive peers are more likely to report having raped or sexually coerced a woman (Heise, 1998).
Macrosystem factors may be described as a broad set of cultural values and beliefs that “permeate and inform the other three layers of the social ecology,” operating through their influence on the other levels (Heise, 1998, p. 277). Most feminist discourse on rape has focused on macrosystem factors such as patriarchy, but it is important to investigate, describe and discuss the impact of other factors (Heise, 1998). A nested, ecological approach acknowledges the important role of macrosystem factors without excluding the validity of contributions at the individual, situational, and social structural levels (Heise, 1998).
There are several macrosystem factors that have been linked to high levels of violence against women. Rigid gender roles have been linked to high incidences of rape in a culture or community; similarly low levels of rape are related to a lack of strongly defined gender roles (Heise, 1998). A sense of male entitlement or ownership of women is another predictor of high levels of violence against women. Also predictive of high levels of violence against women is the culture’s approval of physical punishment of women: in many societies it is perfectly accepted to hit a woman for minor to severe trespasses (which could range from forgetting a meal to adultery to being raped). Over time this normative physical assault can broaden the definition of what is considered acceptable violent behavior towards women (Heise, 1998).
Sexual violence on the scale of mass rape could not be explained without some accounting for the anger and hate directed against the women who are targeted for these attacks (Seifert, 1994). Theorists have asserted that rape of women by men is made possible by the undercurrent of anger, aggression, and hostility towards women that is part of the cultural landscape. Culturally ingrained hatred of or aggression toward women may allow for the possibility that individual men are able to enact the violence of rape (Seifert, 1994).
A cultural ethic of solving problems with violence also predisposes a society to high levels of violence against women, particularly sexual violence (Heise, 1998). The context and history of war can provide a cultural framework where the expected way to resolve conflicts involves violence or aggression, and civilian women become targets for sexual violence in accordance with this cultural principle of violent problem-solving.
Active war can be considered a time when the cultural value of violent problem-solving is most strongly enacted and reinforced. War is present at all levels of the ecological framework, and rape must be contextualized within the violent upheaval of war. Because the meaning and impact of sexual violence are highly dependent upon the social and cultural context in which the violence occurs, it is important to address the significance of wartime rapes (Seifert, 1994).
RAPE IN WAR
Winston Churchill said, “War is a game that is played with a smile,” and war can certainly be likened to a game with rules. These rules or norms of practice during wartime vary across time and place, but the soldiers’ prerogative to rape conquered women has traditionally been an accepted rule of war. To the victor go the spoils. Sexual domination of the “enemy’s women” is one of the benefits afforded to soldiers in battle. These rules dictate that the victor has “the right to exert violence against women… during campaigns of conquest or in the immediate post-war period” (Seifert, 1994). Ancient tests, such as the Iliad and the Old Testament, speak of rape in war. Even the terminology used to discuss sexuality, rape, and war belies the cultural connections between the concept of sexual violence against women and the concept of war: conquests are made in the bedroom and on the battlefield; military invasions may been described as “the rape of” Kuwait, Belgium, etc. (Seifert, 1994). “Rape, pillage, and burn” is a familiar phrase in the contemporary and historical vernacular (Brownmiller, 1994, p. 181).
It is often assumed that rape occurring in times of war is attributable to lawlessness or the wild abandon experienced by soldiers in combat, or the hard earned right of victors to sexually dominate the women of the conquered group. While it is undoubtedly true that some women are raped during war or ethnic conflict for non-strategic reasons, rape and sexual assault are intentionally utilized for military, territorial, social, or political gains. Sexual violence is employed as a tactic in violent conflict because of the physical and psychosocial effects on individuals, families, and communities (Copelon, 1994; Hardy, 2001; MacDonald, 2003; Swiss, 1993; Turshen, 2000).
Rape has always occurred in the wars of known history, and it continues to be a pressing problem in modern wars as its use has become widespread and systematic (Seifert, 1994). But modern women are more than just the spoils of war. Civilians are “the material war is waged with,” and women are considered “war material” to be used in a variety of strategic ways (Seifert, 1994). Many more civilians than soldiers perish in modern wars. “Those who do not carry arms are particularly vulnerable” in active warzones (Seifert, 1994). Women—who in wartime, make up the majority of the civilian population—are “tactical targets of particular significance” because of their role within the family and social structure (Seifert, 1994). Women are singled out as principle targets for the most effective destruction of a culture because of the centrality of their social roles in the family and community.
Wartime rape has been linked strongly to constructions of masculinity offered to soldiers and combatants. Social constructions of masculinity are essential to any discussion of sexual violence against women, and constructions of masculinity during wartime are particularly salient. Military service functions as a rite of passage for many young men, through which they attain an adult male status and identity. A military sociologist described how the values associated with the ideal of sexual virility in the exclusively masculine surroundings of the army become primary for the soldier’s conceptions of himself, as well as his social status (Seifert, 1994).
The social context also provides soldiers with norms that maintain perceived masculine status by the other soldiers (Seifert, 1994). These social values and ideals define the identity of soldiers, and create inner tensions because the soldier is constantly confronted with threats to masculinity (such as emotionality, empathy, horror, fear) and must preserve the construction of masculinity in the face of these “non-masculine” experiences. These cultural conceptions of masculinity as sexually aggressive may increase the likelihood of violence against women because of the normalizing of male dominance and aggression, and the desire to be accepted by other sexually aggressive males (Seifert, 1994).
Sexual violence contains attributes associated with hyper-masculinity (strength, power, forcefulness, domination, and toughness), so the act of rape may be considered a behavior that supports and validates this conception of masculinity. In some social groups, particularly in the context of war and ethnic conflict, rape can also function as a ritualized validation of a soldier’s male status and identity. The hyper-masculinized version of appropriate behavior for men links power and sexuality with violence, linkages that can have dangerous consequences for women who may be the targets of “masculine” displays of sexual violence and domination. Relating masculinity to dominance or toughness (usually important constructions of a soldier’s masculinity) is associated with cultures in which peacetime rape is prevalent (Heise, 1998). It stands to reason that this value of hyper-masculinity could become exaggerated during an active conflict and could increase perpetration of sexual violence against women.
Social pressure may function to spur on hyper-masculinized acts of sexual violence in an attempt to prove one’s manhood or attain the group’s esteem (Heise, 1998). Analysis of gang rapes provides further corroboration for the role of peer pressure and social norms of masculinity in the etiology of rape. The main purpose of gang rape appears to be proving one’s masculinity to the group through the display of sexual violence (Heise, 1998; Seifert, 1994). Attachment to other male peers who encourage abuse or violence against women is a predictive factor for males who abuse women sexually, physically, and psychologically (Heise, 1998). In this way, the macro system value of male dominance and the situational factor of peer pressure (among peers who have all been exposed to the same violent cultural construction of manhood) have a combined influence on the choices of individual men to participate in sexual violence. This provides a strong rationale for the concept that men rape during war because of peer pressure or social norms regarding violence against women, and sexual violence in particular is a way to demonstrate masculine power to the group.
In military conflicts, abuse of women is part of male communication: displays of machismo are enacted through sexual violence against women who are associated with the target males. The rape of women carries a man-to-man message, showing that the targeted men are not able to protect their women (Seifert, 1994). This male communication at the microsystem level is especially salient in cultures which consider women to be the property or social responsibility of their husbands or fathers (Heise, 1998). Men may interpret the sexual assault of “their” women as a direct attack on their manhood and their own integrity. In this way, “women are used as political pawns, as symbols of the potency of the men to whom they belong” (Cahill, 2001, p. 18).
Since “the purity of a woman’s sexual virtue is inextricably linked to the honor of her husband, father, and brothers,” a woman’s survival after being sexually penetrated by the enemy presents an affront to their manhood because the woman becomes a walking reminder of their failure (Hardy, 2001, p. 3). The threat to masculinity posed by rape of women associated with a man may be so severe that it motivates the man to seek revenge, or to turn his anger against the survivor or children born of rape. The crisis in masculinity conveyed through rape may be threatening enough to cause the men in the survivor’s life to isolate the her, cast her out, abuse her, or even murder her, because of the humiliation she represents.
MASS RAPE IN THE CONTEXT OF ETHNIC CONFLICT
During ethnic conflict, the meaning of rape is imbued with a deeper hue: rapes committed in war may aim to destroy the raped woman’s culture or community. Deconstruction of culture—and not necessarily the defeat of the army—can be considered one of the primary goals of rape warfare. Individual rapes translate into an assault on the community through the social emphasis placed on women's sexual virtue: the shame of the rape humiliates all those associated with the survivor. Combatants who rape in war often explicitly link their acts of sexual violence to this broader social degradation through their words and actions (Human Rights Watch, 1996).
When a woman is raped in the context of ethnic conflict and genocide, the symbolic message to the woman’s community is one of territorial conquest. The culture has been symbolically “penetrated” by the enemy, and this is evident in the physical penetration of the individual female representatives. The humiliation of a culture through systematic sexual destruction of the women is the primary goal of mass rape in ethnic conflict.
The female body “functions as a symbolic representation of the body politic [so] the violence inflicted on women is aimed at the physical and personal integrity of the group” (Seifert, 1994, p. 63). The “rape of the women in a community can be regarded as a rape of the body of that community,” and this symbolic assault is very much an intended consequence of genocidal rape (Seifert, 1994, pp. 64). It has been argued that men rape during war and genocide “because the acquisition of the female body means a piece of territory conquered” in symbolic terms (MacKinnnon, 1994, p. 84). Forced sexual penetration (especially when combined with ejaculation and insemination) announces conquest of the woman by the rapist, and by symbolic extension, dominance of the raping culture over the raped culture.
Mass rape in war draws upon existing gender dynamics and cultural factors to increase the damaging effects of the assault (Brownmiller, 1976; Dusauchoit, 2003). In patriarchal cultures, women are considered “symbols of the potency of the men to whom they belong” (Cahill, 2001, p. 18). The tactic of rape robs the husband of his control over his wife’s sexuality during the rape, but also robs him of the ability to sexually enjoy his wife afterwards because she may be injured, traumatized, or pregnant (Amnesty International, 2004). In this way, the male “is emasculated (and therefore dehumanized, rendered powerless) by being denied sole access to his woman” (Cahill, 2001, p. 18-9). This has been described as “the final symbolic expression of the humiliation of the male opponent” (Seifert, 1994, p. 59).
RAPE AS A WAR CRIME
Warfare “proper” is considered to be the confrontation that takes place between soldiers (Seifert, 1994). However, evidence shows that civilians suffer and die in wars to an extreme extent, often wildly outnumbering military deaths. These civilian deaths, while tragic, are not necessarily considered war crimes according to international law. ICTY Deputy Prosecutor Graham Blewitt clarified, “the mere fact that two armies or two parties to a conflict are killing each other is not a war crime: It is only when the parties step beyond the bounds of what is accepted. And modern-day armies are taught what constitutes the laws and customs of war” (Stover, 2005, p. 40).
A war crime is a punishable offense under international law that has been committed during wartime by a soldier or civilian. The 1899 and 1907 Hague Conventions began the establishment of these laws of war, but war crimes became firmly established in the War Crimes Tribunal at Nuermburg in 1945. The Genocide Convention of 1948 and the four Geneva Conventions of 1949 were integral to the development of these laws of war. The International Criminal Court refers to “grave breaches” of the Geneva Convention in its definition of war crimes, particularly the rights and appropriate treatment of civilians, injured soldiers, and prisoners of war.
These and other international treaties form the laws of war, which define what constitutes legal, illegal, and criminal acts. Perpetrating deliberate and unnecessary suffering for civilians may constitute a war crime, while acts that unintentionally harm or kill civilians may not be designated as criminal. The rights of noncombatants in wartime are particularly well outlined in the fourth Geneva Conventions (GCIV, 1949), which mandates humane treatment of all noncombatants. Civilians in wartime are protected by international law from murder, “mutilation, cruel treatment and torture,” and “outrages upon personal dignity, in particular humiliating and degrading treatment” (GCIV, 1949).
Rape may be considered a war crime because the perpetrator deprives the survivor/victim of her right to be treated humanely, and she is exposed to an extreme degree of humiliation, degradation and pain—which is against international law under the fourth Geneva Convention and other international treaties. At Nuremburg, the prosecutors did not deal directly with the issue of rape, although they did admit some evidence regarding sexual violence against women. The Tokyo Tribunal prosecuted rape, but it seemed to be more of an “afterthought” than an intrinsically important part of the judicial process (Stover, 2005). Sexual violence has been handled more directly by the International Criminal Tribunals for the Former Yugoslavia and Rwanda, where the war crime of rape has been prosecuted at the highest levels.
RAPE AS A CRIME AGAINST HUMANITY
The Rome Statute of the International Criminal Court defines “crimes against humanity” as certain acts when “committed as part of a widespread or systematic attack directed at any civilian population” (ICC, 1999, Article 7). The acts include murder, torture, extermination, enslavement, deportation, forcible transfer, imprisonment or other severe deprivation of physical liberty, and other crimes. The Statute specifically lists rape, sexual slavery, forced pregnancy, enforced prostitution, enforced sterilization, and any other form of sexual violence of comparable gravity as crimes against humanity.
The term “crimes against humanity” was first introduced in the 1907 Hague Convention, and it appeared in the record again eight years later when the Allies accused the Ottoman Empire of crimes against humanity (Stover, 2005). It was not explicitly linked to sexual violence. Later the concept was once again utilized (this time as a basis for levying charges against the Nazis at the Nuremburg trials) again without directly referencing rape as a crime against humanity (Stover, 2005).
The International Criminal Tribunal on Yugoslavia (ICTY) was the first time that rape had been charged as a crime against humanity. The prosecution argued that witness testimony established that a crime against humanity was committed in Foca, including a “widespread or systematic pattern of sexual assaults” (Hagan, 2003, p. 190). The rape trials at the ICTY presented evidence of “an organized campaign of rape and sexual assault upon various women at various locations over a prolonged period of time” (Kunarac transcripts, p. 332, as cited in Hagan, 2003, p. 183). At the trials, there was also discussion of the “policy of ethnic cleansing unleashed by the Bosnian Serb leadership on the non-Serb population,” of which mass rape was an essential strategy (Kunarac transcripts, p. 303, as cited in Hagan, 2003, p. 183). Human Rights Watch (2005) has declared the sexual violence to be “a fundamental violation of human rights,” and has further stated that “acts of sexual violence committed as part of widespread or systematic attacks against a civilian population in Darfur can be classified as crimes against humanity” (para. 12).
RAPE AS AN ACT OF GENOCIDE
While rape may seem antithetical to genocide, it is often a cornerstone of these brutal campaigns because of the devastating effects on women, families, and communities. Genocide was defined by the United Nations as “acts committed with intent to destroy, in whole or in part, a national, ethnical, racial or religious group” (UN, 1948, Article II). These acts may include killing, causing serious bodily or mental harm, deliberately inflicting conditions of life calculated to bring about the group’s physical destruction, imposing measures intended to prevent births, or forcibly removing children from the group (UN, 1948, Article II). Rape is a forced sexual penetration that can cause death, serious bodily and mental harm, bring about physical destruction of the group, and can impede births. Thus rape can be considered an act of genocide and it has been recognized as such by international criminal courts.
Mass rape is a strategy of genocide because it is a condition calculated to bring about physical destruction of the group. Mass rape prevents births within the target group through damage to reproductive capacities or social fitness of women. In-group births may be prevented through forced impregnation. Children born of rape are seen by the mother’s community as a soiling the group’s bloodlines, while the perpetrators may consider the woman and the child to have been “ethnically cleansed” through the assault (MacKinnon, 1994, p. 191). Many communities believe that the survivor has been penetrated and thus tainted by “the enemy:” the child born of rape is generally considered an enemy or a pariah in the community.
Rape and sexual violence may be particularly destructive when they occur within the context of ethnic cleansing or genocide, and it is necessary to attend to factors that amplify the significance ascribed to these acts. Rape can be a strategy of war, ethnic cleansing, and genocide because it reduces the civilian population through a variety of practical means while instilling fear, submission, compliance, and fleeing from areas of contested territory (International, 2005; MacKinnon, 1994). Survivors, family members, and witnesses tend to avoid traumatic reminders such as the location of the rape (International, 2005; Zalihic-Kaurin, 1994). Brutal and public rapes remove the desire to return to the areas where the traumatic events took place for large numbers of people at once. When rapes are committed in a widespread and systematic fashion, these assaults on women come to represent an assault on the community (MacDonald, 2003). Mass rapes “reverberate through the decades and across the borders and have a lasting effect on the position, identity, and self of women” (Seifert, 1994).
Médicins Sans Frontières (Doctors Without Borders) describe rape as a “weapon used to destabilize or even break a particular ethnic, national, or religious group or to ‘ethnically cleanse’ a whole society” (Dusauchoit, 2003, p. 3). In the context of ethnic cleansing and genocide, the trauma of rape may be intentionally maximized by the perpetrator(s) to cause damage or death, and to send a message. Physical abuse or torture, repeated assaults or gang rapes over a span of time from days to weeks, forced pregnancy and childbirth, the combination of rape with murder or torture of the survivor’s loved ones, public humiliation of the survivor and her family, and verbal abuse of the survivor and her community contribute to the devastation (Kozaric-Kovacic, 1995a; Turshen, 2000). Mass rapes are combined with organized slaughter, looting, burning, pillaging, and starvation for exponential impact (Fischman, 1996; Frljak, 1997; Swiss, 1993).
After the rulings of the International Tribunal on the former Yugoslavia, Patricia Sellers (the legal advisor for gender-related crimes) stated “now we can say rape is a crime, a crime against humanity, or a war crime, a constituent part of genocide” (as quoted in Hagan, 2003, p. 201). These landmark rulings paved the way for future perpetrators of genocidal rape to be held accountable for their actions.
Sunday, March 25, 2007
Physical Problems Caused by Mass Rape
The physical consequences of rape are severe, acute, and long-lasting. Women are raped and killed, or raped and left to die, or they survive only to be raped again next time they venture outside. In the conflicts described, the brutality of the attacks is extreme and physical injuries are common. Rape can cause population decrease, especially when it is applied in a widespread and systematic manner as in Bosnia-Hercegovina, Rwanda, and Darfur. An estimated 90% of the casualties in the Bosnian wars were civilian women and children (Swiss & Giller, 1993). Many of these civilians were raped, including elderly women and young girls.
If a woman survives the sexual assault, she may have contracted diseases or she may be severely injured, possibly permanently disabled. The survivor may die later as a result of the rape through illness, infection, suicide or murder. Many survivors of wartime or genocidal rape commit suicide following their ordeal, or die in an attempt to abort the fetus. It is also common for a woman to be killed by her own family or community after experiencing rape, because of the shame the assault brings on the family and community.
In some cultures, rape is be considered worse than death, because the victim lives through the experience, causing further trauma and suffering to the individual. IN the context of genocide, rape can be worse than death because the survivors broadcast a message of defeat/conquest to the community of the victimized woman which can demoralize and terrify them. One Rwandan rape survivor reported, “On the third day [of constant gang rape], one Interahamwe…told me that I had already died and could go” (Human Rights Watch, 1996). Many survivors “see themselves as dead already” (Rinaldo, 2004). Another survivor wished she had died:
“Today I regret that I didn't die that day. Those men and women who died are now at peace whereas I am still here to suffer even more. I'm handicapped in the true sense of the word. I don't know how to explain it. I regret that I'm alive because I've lost my lust for life. We survivors are broken-hearted. We live in a situation which overwhelms us. Our wounds become deeper every day. We are constantly in mourning” (African Rights, 2004).
“Rape has been termed ‘social murder’ or death” because rape resembles death, except the victim may live through it (Cahill, 2001, p. 131). One survivor reported that she “wanted to die;” others reported that they were constantly surprised that they were still alive because of the emotional numbing they experienced for years after the rape (Kozaric-Kovacic, et al., 1995, p. 430; African Rights, 2004). “To be raped—to have one’s body violated by another person’s body in a particularly sexual way—can mean the destruction of the person one has been up to that point” and many victims either wish that they were dead or consider themselves to be dead even as they live (Cahill, 2001, p. 131). Many societies consider a woman to be destroyed after a rape has occurred, so women are not encouraged to heal or to consider that their life can continue after the assault (Boose, 2002). Rape is utilized during genocide campaigns because it accomplishes two goals at once: the woman is effectively “killed” or loses the will to live, yet she goes on living among her people as a constant reminder of their downfall (Cahill, 2001, p. 13).
Women who survive genocidal rape are often plagued by sexually transmitted diseases, including HIV/AIDS, which can be spread to partners and children. Sexually transmitted diseases take on a particular salience during ethnic conflict and genocide. Transmission of the HIV virus through mass rape may be used as a strategy of population reduction, and unintentional spreading of HIV is also facilitated by mass rape. The virus may be transmitted at elevated levels when violent sexual attacks involving heightened contact with blood and other bodily fluids occur on a large scale. Due to the stigma of HIV/AIDS and the lack of access to diagnosis and treatment, the disease leaves a legacy of suffering, humiliation, and death for survivors, their children and families after mass rape.
Transmission of HIV was used in Bosnian rape camps as a way to decrease the population over time, as well as to humiliate the woman and her family by infecting her with a sexually transmitted disease. The children born of these mass rapes, many of them orphans, were infected with HIV at alarming rates, and many of them have died.
According to Rwandan doctors, the most common medical problems for raped women are sexually transmitted diseases, including HIV/AIDS. In Rwanda, an estimated 70-90% of rape victims have contracted HIV/AIDS. Recalling that over 500,000 women were raped, the health crisis created by this epidemic is staggering. Advocacy groups argue that the 1994 genocide never ended, because it is still claiming victims today. UNICEF reports that many of these women had not been sexually active prior to the rapes.
Similarly, in Darfur, the health crisis caused by mass rape of women and girls is reaching desperate proportions (Human Rights Watch, 2005). Rates of HIV have skyrocketed in Darfur and Eastern Chad as rampant sexual violence spreads the disease. In 2003 the HIV rates for Darfur and Chad were 2.3% and 4.8% respectively (Watch, 2005). In 2006, it is reported that 11% of 180 people tested HIV-positive at a voluntary counseling and testing clinic in Nyala, the capital of South Darfur state ("Faith-Based Groups Partnering To Fight HIV/AIDS Epidemic In Sudan's Darfur Region," 2006)HIV and other sexually transmitted infections and diseases reduce the population over time, and these problems will have to be addressed by disorganized and under-funded health care providers.
Clinics are unprepared to handle the influx of affected women, and do not possess the necessary equipment and training to respond effectively to mass rape. As of February 2005 only one of the six health service agencies in Chad’s refugee camps had a protocol for rape including emergency contraception, comprehensive treatment of sexually transmitted disease and post-exposure prophylaxis for HIV (Human Rights Watch, 2005). Darfur will need considerable assistance to address the health crisis that this conflict has created.
Because of political factors in the Sudan, Bosnia-Hercegovina, and Rwanda, it is difficult for women who have been raped to obtain gynecological and obstetric care without exposing themselves to arrest, fines, or bureaucratic nightmares. Shame about the sexual nature of the assault and the injuries stemming from it also prevent women from seeking medical services.
Women attending a gynecological outpatient clinic in Bosnia-Herzegovina in a war zone were likely to report “vaginal discharge [including blood], pelvic pain, pregnancy and amenorrhea” as their primary symptoms, but most were hesitant to reveal that they had been raped (Frljak et al., 1997). Correlations were found between war trauma, physical and sexual abuse, and pelvic pain as reported by women utilizing the clinic’s services (Frljak et al., 1997). Often victims’ future reproductive capacities were destroyed through violent physical injuries received during the rape, which has significant consequences for the community’s ability to repopulate after mass rapes deprive a generation of child-bearing women of the ability to do so.
Each conflict seemed to have particular types of physical injuries that left the survivor with a painful memory of the experience. In Darfur, it is common for the assailant to break the survivor’s legs and/or arms after raping her. In Rwanda, women were regularly branded, cut or mutilated with machetes, and men were routinely castrated. Extreme forms of genital mutilation was a common feature of rape in order to cause pain and suffering, as well as permanent sexual scarring to make the women unacceptable as wives in their own communities. These sexualized scars made it impossible for survivors to hide the fact that they had been raped. In a number of cases, doctors have performed reconstructive surgery for women and girls who suffered sexual mutilation at the hands of their attackers, but this has not been available to the vast majority of affected women.
The intention of forced pregnancy is “to alienate women’s reproductive as well as productive rights [through] rape to impregnate, making women bear children for the ‘enemy’ community,” and making her unfit or unable to bear children of her own ethnicity (Turshen, 2000, p. 6). Symbolically, forced pregnancy represents the conquest of the woman’s body by “enemy sperm” and it is perceived as a conquest of the raped culture by the raping culture (Copelon, 1994, p. 207).
Bosnian rape survivors frequently reported Serbian rapists “triumphantly jeering after reaching orgasm that the woman was now carrying ‘Serb seed’ and would produce a ‘Serb baby’” (Boose, 2002, p. 72). Pregnant Muslims were freed from rape camps amid the announcement that, “you’re going to have a Serb baby” (Hagan, 2003). This was demoralizing and destructive to their communities because it represented a decrease in the Muslim population from a symbolic perspective. Despite the mother’s ethnic identity, “babies made with Muslim and Croat women are regarded… as Serb babies” in the context of ethnic cleansing (MacKinnon, 1994, p. 191). Beyond cultural factors “a ‘Serb baby’ would be indistinguishable from a ‘Bosnian Muslim’ one,” because there are not biological distinguishers between the groups, but the symbolic difference is very important to the people involved in the conflict (Boose, 2002, p. 73).
Rape with intent to impregnate is a central strategy utilized by the Janjawid and military officers perpetrating mass rape in Darfur. As in many Arab cultures, Sudanese children’s ethnicity is derived solely from their father (Wax, 2004). The rapes occur as part of a strategy to increase Arabization of the people of Sudan. It is believed that an Arab father produces an Arab baby and this symbolic and cultural information becomes a weapon of genocide and a tool of ethnic cleansing when applied in this manner.
As one aid worker in Darfur stated, "Everyone knows how the father carries the lineage in the culture. They want more Arab babies to take the land” (Wax, 2004). One survivor reported the Janjawid said to her, “Black girl, you are too dark. You are like a dog. We want to make a light baby… You get out of this area and leave the child when it's made.” (Wax, 2004).
The absolute domination of a community’s women through forced pregnancy on a mass scale showcases the intimate conquest of the culture in an undeniably physical form. During the Bosnian War, “Buses filled with women in the sixth, seventh, or later month of pregnancy are sent back over enemy lines, usually with cynical inscriptions on the vehicles regarding the children about to be born” (Seifert, 1994, p. 59). These forcibly impregnated women were living symbols of the Serb conquest: beaten and raped, barely alive, their abdomens swollen with “Serb babies,” these women stumbled home to their people only to be discarded, shunned, or killed.
Many pregnant survivors seek abortions, but this is difficult in times of war and in conservative, religious countries. In this way, sexual violence also exposes women to potentially unsafe abortions and traumatic, complicated childbirths in areas without adequate medical care (Classen, 2005). Because of these conditions, pregnant rape survivors take extreme measures to abort or injure the fetus, which may also cause damage to the woman herself. Many of these women die in childbirth. In this way, unwanted pregnancy and subsequent abortion, miscarriage, or complicated birth lead to decreases in the raped population (Ahrens & Campbell, 2000; Amnesty International, 2004; Classen, Palesh, & Aggarwal, 2005; Campbell & Wasco, 2005; Wasco, 2003; Wiljma et al, 2000).
In Rwanda, abortion was illegal and unavailable to survivors, and Rwandan doctors reported treating survivors with serious complications resulting from self-induced or clandestine abortions arising from rape-related pregnancies. An estimated 2,500 “bad memory babies” were born following the genocide and many were abandoned (Human Rights Watch, 1996). It is additionally reported by the Rwandan Ministry of Health that 5,500 women had abortions in the aftermath of the genocide.
In Darfur, it is believed that women can only conceive during consensual sex, not during rape (Amnesty International, 2004). It is considered evidence of the woman’s consent, enjoyment, or participation if she becomes pregnant as a result of a sexual assault. Pregnant women who are raped may be fined or imprisoned for adultery in Darfur, which is a traumatic for those women who try to seek help from the authorities.
An estimated 5,000 infants were abandoned or killed in the aftermath of genocidal rape in the Balkans (Hardy, 2001, p. 4). Pregnant survivors often rejected both the pregnancy and the children, and those who were detained until advanced stages of pregnancy before delivering the infant tended to consider the “fetus to be a foreign body,” or a representative of the enemy (Kozaric-Kovacic, et al., 1995, p. 429). Senada, a raped Bosnian woman who decided to kill her baby after it was born remarked, “I knew it wasn’t my kid… this kid has nothing to do with me… If I’d had any chance to kill the kid inside me, I’d have done it” (Stiglmayer, 1994, p. 133). The child was rescued and adopted without the mother’s consent (Stiglmayer, 1994).
Pregnant survivors described feeling betrayed by their bodies, and experienced “denial, severe depression, neglect or rejection of the child after its birth” (Folnegovic-Smalc, 1994, p. 177). Others were elated after the delivery, death, or abandonment of the babies (Folnegovic-Smalc, 1994). This elation stemmed from disconnecting physically from the baby and experiencing an embodied liberation from the conquest of the raping culture.
Children of rape and the mothers who bear them are stigmatized and socially punished within their own communities. The children are not accepted because they are viewed as the “enemy,” because of the father’s identity (Copelon, 1994; Turshen, 2000). These children and their mothers have been largely outcast and shunned because of the continued stigma they bring upon their families as a constant reminder of the trauma the family and the community have suffered.
Women and their communities reject babies born of rape because they represent the humiliation of the mother and the culture itself. Sometimes communities will reaccept a raped woman if she abandons, aborts, or destroys the baby. There may be considerable pressure on pregnant rape survivors to decide what to do with the child, because there are extreme consequences associated with each potential outcome (WHO, 2002).
In the aftermath of genocidal rape, children are left without mothers, and many of these orphans die. Some orphans have been victims of rape themselves, as survivors report that girls as young as 6 were raped along with the women and older girls (Human Rights Watch, 1996). Many of these orphans are also infected with HIV/AIDS. According to the Survivors Fund, a London-based aid agency, genocide widows look after an average of seven orphans each (Hilsum, 2004). The Rwandan government estimates that there are approximately 250,000 widows and 300,000 orphans or unaccompanied children (Lorch, 1995). The future of these half-Tutsi, half-Hutu orphans is uncertain at best; currently they are placed in orphanages, classified as “genocide orphans” to protect their anonymity (Lorch, 1995).
Mass rape campaigns leave survivors with a myriad of physical problems including illness, injuries, and pregnancies that must be handled. There is often very little medical care available to address physical needs and symptoms, and this lack of care is problematic in more ways than one. During the International Criminal Tribunal on The former Yugoslavia, survivors testified about the rapes they had experienced, and medical professional witnesses testified that they were “shocked” that no medical evidence could be presented to the court (Hagan, 2003, p. 197). These experts then asserted that rape charges have to be medically proven, since the women could have lied about what happened, and remarked that “without a file, it’s as if the rape did not happen” (Hagan, 2003, p. 197). It is essential to document the scope and extent of acute and chronic health problems caused by mass rape, so that appropriate interventions can be developed, and justices can be served in the courts.
Death
The simplest and most direct way that rape decreases population is that many women are raped and beaten to death. It is common for a woman to lose consciousness and die during or shortly after rape (Swiss & Giller, 1993). Many more are murdered, tortured, or beaten to death after being sexually assaulted (Amnesty International, 2004). Some are abandoned in areas where they cannot survive, or they may be purposely crippled and left too far from help. Survivors abandoned in varying levels of consciousness and injury may die of exposure, dehydration, starvation, or animal attacks. Médicins Sans Fronteirès described in this context rape as a matter “of life and death” (Dusauchoit, 2003, p. 2). These women and girls died through violent and torturous “rape unto death, rape as massacre, rape to kill and to make the victims wish they were dead” (MacKinnon, 1994, p. 190). Many were beaten to death or shot after being sexually assaulted; some victims even begged their abusers to kill them (Stiglmayer, 1994).If a woman survives the sexual assault, she may have contracted diseases or she may be severely injured, possibly permanently disabled. The survivor may die later as a result of the rape through illness, infection, suicide or murder. Many survivors of wartime or genocidal rape commit suicide following their ordeal, or die in an attempt to abort the fetus. It is also common for a woman to be killed by her own family or community after experiencing rape, because of the shame the assault brings on the family and community.
Suicide
Rape survivors often report suicidal thoughts or attempt suicide as a result of the assault. Many survivors seeking psychiatric assistance at a clinic in Croatia sought help because they had recently attempted suicide in the aftermath of sexual assault (Kozaric-Kovocic, Folnegovic-Smalc & Skrinjaric, 1993). Pregnant rape survivors reported the highest rates of suicidal ideation among rape survivors at Bosnian clinics (Kozaric-Kovacic, 1993; Kozaric-Kovacic, 1995b). The numbed emotional state of rape victims with PTSD has been described as similar to a waking death, and most rape victims experienced suicidal ideations although only some had acted upon these feelings (Kozaric-Kovacic, 1995b). Survivors with PTSD may have a sense of foreshortened future. For many survivors of genocidal rape, “forshortened future” accurately describes the practical reality of their lives. A survivor may have lived through the attack, but she does not know what will happen tomorrow, and what new terrors will threaten her physical integrity (American Psychiatric Association, APA, 2000, p. 220).In some cultures, rape is be considered worse than death, because the victim lives through the experience, causing further trauma and suffering to the individual. IN the context of genocide, rape can be worse than death because the survivors broadcast a message of defeat/conquest to the community of the victimized woman which can demoralize and terrify them. One Rwandan rape survivor reported, “On the third day [of constant gang rape], one Interahamwe…told me that I had already died and could go” (Human Rights Watch, 1996). Many survivors “see themselves as dead already” (Rinaldo, 2004). Another survivor wished she had died:
“Today I regret that I didn't die that day. Those men and women who died are now at peace whereas I am still here to suffer even more. I'm handicapped in the true sense of the word. I don't know how to explain it. I regret that I'm alive because I've lost my lust for life. We survivors are broken-hearted. We live in a situation which overwhelms us. Our wounds become deeper every day. We are constantly in mourning” (African Rights, 2004).
“Rape has been termed ‘social murder’ or death” because rape resembles death, except the victim may live through it (Cahill, 2001, p. 131). One survivor reported that she “wanted to die;” others reported that they were constantly surprised that they were still alive because of the emotional numbing they experienced for years after the rape (Kozaric-Kovacic, et al., 1995, p. 430; African Rights, 2004). “To be raped—to have one’s body violated by another person’s body in a particularly sexual way—can mean the destruction of the person one has been up to that point” and many victims either wish that they were dead or consider themselves to be dead even as they live (Cahill, 2001, p. 131). Many societies consider a woman to be destroyed after a rape has occurred, so women are not encouraged to heal or to consider that their life can continue after the assault (Boose, 2002). Rape is utilized during genocide campaigns because it accomplishes two goals at once: the woman is effectively “killed” or loses the will to live, yet she goes on living among her people as a constant reminder of their downfall (Cahill, 2001, p. 13).
Infection and Illness
Infections and illnesses like HIV, hepatitis, syphilis, and others are common in survivors of wartime sexual assault. Additionally, survivors are more likely to experience acute and chronic health problems than women who have not experienced sexual assault (Wasco, 2003; Wijma, Soderquist, Bjorklund, & Wijma, 2000). Survivors report higher rates of diseases such as diabetes, asthma, and arthritis (Wasco, 2003). Somatic complaints, especially unexplained abdominal pain, are common among survivors of sexual assault (DiLillo, Tremblay, & Peterson, 2000; Wasco, 2003; Wiljma et al, 2000). Physical health problems may lead to or exacerbate a decline occupational, parental, or psychosocial functioning (Amnesty International, 2004; Campbell & Wasco, 2005).Women who survive genocidal rape are often plagued by sexually transmitted diseases, including HIV/AIDS, which can be spread to partners and children. Sexually transmitted diseases take on a particular salience during ethnic conflict and genocide. Transmission of the HIV virus through mass rape may be used as a strategy of population reduction, and unintentional spreading of HIV is also facilitated by mass rape. The virus may be transmitted at elevated levels when violent sexual attacks involving heightened contact with blood and other bodily fluids occur on a large scale. Due to the stigma of HIV/AIDS and the lack of access to diagnosis and treatment, the disease leaves a legacy of suffering, humiliation, and death for survivors, their children and families after mass rape.
Transmission of HIV was used in Bosnian rape camps as a way to decrease the population over time, as well as to humiliate the woman and her family by infecting her with a sexually transmitted disease. The children born of these mass rapes, many of them orphans, were infected with HIV at alarming rates, and many of them have died.
According to Rwandan doctors, the most common medical problems for raped women are sexually transmitted diseases, including HIV/AIDS. In Rwanda, an estimated 70-90% of rape victims have contracted HIV/AIDS. Recalling that over 500,000 women were raped, the health crisis created by this epidemic is staggering. Advocacy groups argue that the 1994 genocide never ended, because it is still claiming victims today. UNICEF reports that many of these women had not been sexually active prior to the rapes.
Similarly, in Darfur, the health crisis caused by mass rape of women and girls is reaching desperate proportions (Human Rights Watch, 2005). Rates of HIV have skyrocketed in Darfur and Eastern Chad as rampant sexual violence spreads the disease. In 2003 the HIV rates for Darfur and Chad were 2.3% and 4.8% respectively (Watch, 2005). In 2006, it is reported that 11% of 180 people tested HIV-positive at a voluntary counseling and testing clinic in Nyala, the capital of South Darfur state ("Faith-Based Groups Partnering To Fight HIV/AIDS Epidemic In Sudan's Darfur Region," 2006)HIV and other sexually transmitted infections and diseases reduce the population over time, and these problems will have to be addressed by disorganized and under-funded health care providers.
Clinics are unprepared to handle the influx of affected women, and do not possess the necessary equipment and training to respond effectively to mass rape. As of February 2005 only one of the six health service agencies in Chad’s refugee camps had a protocol for rape including emergency contraception, comprehensive treatment of sexually transmitted disease and post-exposure prophylaxis for HIV (Human Rights Watch, 2005). Darfur will need considerable assistance to address the health crisis that this conflict has created.
Injury
Sexual violence can cause numerous medical consequences, including internal bleeding, fistulas, incontinence, and life-threatening injuries (WHO, 2002). Survivors’ health and reproductive capacities may be damaged by physical injuries received during rape (Amnesty International, 2004). Severe injuries, such as cuts, burns, or gunshot wounds to the genital or abdominal areas may destroy the possibility survivors bearing children in the future. Survivors may experience torn vaginal walls that result in chronic fecal or urinary incontinence through the vaginal canal. In areas where sanitation is questionable, these types of injuries increase survivors’ vulnerability to infections. Breasts may have been cut or severed, and many women were gutted after their assault; some of these women survived, but there is little opportunity for proper medical treatment or reconstruction. These physical consequences of rape and sexual torture are painful, embarrassing, and stigmatizing for the survivor. Because of political factors in the Sudan, Bosnia-Hercegovina, and Rwanda, it is difficult for women who have been raped to obtain gynecological and obstetric care without exposing themselves to arrest, fines, or bureaucratic nightmares. Shame about the sexual nature of the assault and the injuries stemming from it also prevent women from seeking medical services.
Women attending a gynecological outpatient clinic in Bosnia-Herzegovina in a war zone were likely to report “vaginal discharge [including blood], pelvic pain, pregnancy and amenorrhea” as their primary symptoms, but most were hesitant to reveal that they had been raped (Frljak et al., 1997). Correlations were found between war trauma, physical and sexual abuse, and pelvic pain as reported by women utilizing the clinic’s services (Frljak et al., 1997). Often victims’ future reproductive capacities were destroyed through violent physical injuries received during the rape, which has significant consequences for the community’s ability to repopulate after mass rapes deprive a generation of child-bearing women of the ability to do so.
Each conflict seemed to have particular types of physical injuries that left the survivor with a painful memory of the experience. In Darfur, it is common for the assailant to break the survivor’s legs and/or arms after raping her. In Rwanda, women were regularly branded, cut or mutilated with machetes, and men were routinely castrated. Extreme forms of genital mutilation was a common feature of rape in order to cause pain and suffering, as well as permanent sexual scarring to make the women unacceptable as wives in their own communities. These sexualized scars made it impossible for survivors to hide the fact that they had been raped. In a number of cases, doctors have performed reconstructive surgery for women and girls who suffered sexual mutilation at the hands of their attackers, but this has not been available to the vast majority of affected women.
Pregnancy
Women who have been raped may become pregnant, especially when kept in conditions where conception is likely. In Bosnia-Hercegovina, the most common physical consequence of rape was pregnancy, owing to the importance of forced pregnancy in the Serbian strategy. When rape results in pregnancy, many survivors face the agonizing choice to abandon the baby or be abandoned by her own family or community (WHO, 2002). Babies born of rape are rejected because they represent the humiliation of the mother, the family, and the culture itself. Impregnated women cannot help delivering the raping culture’s message of conquest as they cannot help delivering the children of rape, and they are condemned for both.The intention of forced pregnancy is “to alienate women’s reproductive as well as productive rights [through] rape to impregnate, making women bear children for the ‘enemy’ community,” and making her unfit or unable to bear children of her own ethnicity (Turshen, 2000, p. 6). Symbolically, forced pregnancy represents the conquest of the woman’s body by “enemy sperm” and it is perceived as a conquest of the raped culture by the raping culture (Copelon, 1994, p. 207).
Bosnian rape survivors frequently reported Serbian rapists “triumphantly jeering after reaching orgasm that the woman was now carrying ‘Serb seed’ and would produce a ‘Serb baby’” (Boose, 2002, p. 72). Pregnant Muslims were freed from rape camps amid the announcement that, “you’re going to have a Serb baby” (Hagan, 2003). This was demoralizing and destructive to their communities because it represented a decrease in the Muslim population from a symbolic perspective. Despite the mother’s ethnic identity, “babies made with Muslim and Croat women are regarded… as Serb babies” in the context of ethnic cleansing (MacKinnon, 1994, p. 191). Beyond cultural factors “a ‘Serb baby’ would be indistinguishable from a ‘Bosnian Muslim’ one,” because there are not biological distinguishers between the groups, but the symbolic difference is very important to the people involved in the conflict (Boose, 2002, p. 73).
Rape with intent to impregnate is a central strategy utilized by the Janjawid and military officers perpetrating mass rape in Darfur. As in many Arab cultures, Sudanese children’s ethnicity is derived solely from their father (Wax, 2004). The rapes occur as part of a strategy to increase Arabization of the people of Sudan. It is believed that an Arab father produces an Arab baby and this symbolic and cultural information becomes a weapon of genocide and a tool of ethnic cleansing when applied in this manner.
As one aid worker in Darfur stated, "Everyone knows how the father carries the lineage in the culture. They want more Arab babies to take the land” (Wax, 2004). One survivor reported the Janjawid said to her, “Black girl, you are too dark. You are like a dog. We want to make a light baby… You get out of this area and leave the child when it's made.” (Wax, 2004).
The absolute domination of a community’s women through forced pregnancy on a mass scale showcases the intimate conquest of the culture in an undeniably physical form. During the Bosnian War, “Buses filled with women in the sixth, seventh, or later month of pregnancy are sent back over enemy lines, usually with cynical inscriptions on the vehicles regarding the children about to be born” (Seifert, 1994, p. 59). These forcibly impregnated women were living symbols of the Serb conquest: beaten and raped, barely alive, their abdomens swollen with “Serb babies,” these women stumbled home to their people only to be discarded, shunned, or killed.
Many pregnant survivors seek abortions, but this is difficult in times of war and in conservative, religious countries. In this way, sexual violence also exposes women to potentially unsafe abortions and traumatic, complicated childbirths in areas without adequate medical care (Classen, 2005). Because of these conditions, pregnant rape survivors take extreme measures to abort or injure the fetus, which may also cause damage to the woman herself. Many of these women die in childbirth. In this way, unwanted pregnancy and subsequent abortion, miscarriage, or complicated birth lead to decreases in the raped population (Ahrens & Campbell, 2000; Amnesty International, 2004; Classen, Palesh, & Aggarwal, 2005; Campbell & Wasco, 2005; Wasco, 2003; Wiljma et al, 2000).
In Rwanda, abortion was illegal and unavailable to survivors, and Rwandan doctors reported treating survivors with serious complications resulting from self-induced or clandestine abortions arising from rape-related pregnancies. An estimated 2,500 “bad memory babies” were born following the genocide and many were abandoned (Human Rights Watch, 1996). It is additionally reported by the Rwandan Ministry of Health that 5,500 women had abortions in the aftermath of the genocide.
In Darfur, it is believed that women can only conceive during consensual sex, not during rape (Amnesty International, 2004). It is considered evidence of the woman’s consent, enjoyment, or participation if she becomes pregnant as a result of a sexual assault. Pregnant women who are raped may be fined or imprisoned for adultery in Darfur, which is a traumatic for those women who try to seek help from the authorities.
An estimated 5,000 infants were abandoned or killed in the aftermath of genocidal rape in the Balkans (Hardy, 2001, p. 4). Pregnant survivors often rejected both the pregnancy and the children, and those who were detained until advanced stages of pregnancy before delivering the infant tended to consider the “fetus to be a foreign body,” or a representative of the enemy (Kozaric-Kovacic, et al., 1995, p. 429). Senada, a raped Bosnian woman who decided to kill her baby after it was born remarked, “I knew it wasn’t my kid… this kid has nothing to do with me… If I’d had any chance to kill the kid inside me, I’d have done it” (Stiglmayer, 1994, p. 133). The child was rescued and adopted without the mother’s consent (Stiglmayer, 1994).
Pregnant survivors described feeling betrayed by their bodies, and experienced “denial, severe depression, neglect or rejection of the child after its birth” (Folnegovic-Smalc, 1994, p. 177). Others were elated after the delivery, death, or abandonment of the babies (Folnegovic-Smalc, 1994). This elation stemmed from disconnecting physically from the baby and experiencing an embodied liberation from the conquest of the raping culture.
Children of rape and the mothers who bear them are stigmatized and socially punished within their own communities. The children are not accepted because they are viewed as the “enemy,” because of the father’s identity (Copelon, 1994; Turshen, 2000). These children and their mothers have been largely outcast and shunned because of the continued stigma they bring upon their families as a constant reminder of the trauma the family and the community have suffered.
Women and their communities reject babies born of rape because they represent the humiliation of the mother and the culture itself. Sometimes communities will reaccept a raped woman if she abandons, aborts, or destroys the baby. There may be considerable pressure on pregnant rape survivors to decide what to do with the child, because there are extreme consequences associated with each potential outcome (WHO, 2002).
In the aftermath of genocidal rape, children are left without mothers, and many of these orphans die. Some orphans have been victims of rape themselves, as survivors report that girls as young as 6 were raped along with the women and older girls (Human Rights Watch, 1996). Many of these orphans are also infected with HIV/AIDS. According to the Survivors Fund, a London-based aid agency, genocide widows look after an average of seven orphans each (Hilsum, 2004). The Rwandan government estimates that there are approximately 250,000 widows and 300,000 orphans or unaccompanied children (Lorch, 1995). The future of these half-Tutsi, half-Hutu orphans is uncertain at best; currently they are placed in orphanages, classified as “genocide orphans” to protect their anonymity (Lorch, 1995).
Mass rape campaigns leave survivors with a myriad of physical problems including illness, injuries, and pregnancies that must be handled. There is often very little medical care available to address physical needs and symptoms, and this lack of care is problematic in more ways than one. During the International Criminal Tribunal on The former Yugoslavia, survivors testified about the rapes they had experienced, and medical professional witnesses testified that they were “shocked” that no medical evidence could be presented to the court (Hagan, 2003, p. 197). These experts then asserted that rape charges have to be medically proven, since the women could have lied about what happened, and remarked that “without a file, it’s as if the rape did not happen” (Hagan, 2003, p. 197). It is essential to document the scope and extent of acute and chronic health problems caused by mass rape, so that appropriate interventions can be developed, and justices can be served in the courts.
Psychosocial Problems Caused by Mass Rape
Sexual assault can affect long-term physical, psychological, and relational health, and further inquiry will continue to elucidate relationships between resilience, vulnerability, and contextual factors in the development of the traumatic response (Allen, 2003; Campbell & Wasco, 2005; DiLillo & Damashek, 2003; Messman-Moore & Long, 2000; Wasco, 2003). Mass rape causes psychological and social problems for women and their families, but it is difficult to assess the true level of devastation left in the wake of these brutal campaigns because often assessment or intervention services are not available to women in these war zones, rape camps, or internally displaced persons camps (Muller, 2000).
The World Health Organization (2002) lists anxiety, anger, shame, depression, post-traumatic stress, and suicide as potential psychological consequences of sexual violence. However, it must be acknowledged that even the “terms by which psychology understands the word rape are rendered grossly insufficient, if not meaningless by the experiences” of mass rape survivors in Darfur, Rwanda, and Bosnia-Hercegovina because of the level of compound traumas these women have suffered (Boose, 2002, p. 71).
Genocidal rape survivors have been exposed to “interactive traumatic stressors;” they have been emotionally and physically impacted in ways that psychology is not prepared to handle (Fischman, 1996, p. 161). These additional traumas can include detention in rape camps, forced pregnancy, death of loved ones, threat to survival, torture, war-related illnesses or injuries, “loss of home and community,” “stresses of migration and dislocation, cultural shock, lack of familiar support systems, and fear of deportation” (Fischman, 1996, p. 161). The victim’s sense of structure and safety may have been shattered by the compound traumas she has experienced. Rapes may be combined with physical abuse and torture, starvation, verbal abuse, and other forms of domination and humiliation in order to maximize the trauma to the survivor. Weapons such as guns, axes, and whips were commonly used to intimidate and threaten the women in Darfur, while machetes and AK-47s were wielded in Rwanda. It has been shown that these techniques often increase the intensity of the traumatic response (Physicians for Human Rights, PHR, 2006).
The survivor’s psychological response may be influenced by the context and level of brutality of the assault. Rapists often used dehumanizing epithets and racialized or gendered slurs directed at the raped woman and her community. In Daufur, “slave” and “black slave” are common ways the perpetrators refer to African women from the Fur, Masalit and Zaghawa ethnic groups (Wax, 2004). In Bosnia-Hercegovina, women were commonly called “Turks” or “Ustasha whores” (Boose, 2002). This form of ethnically oriented verbal abuse increases the suffering of the raped woman, and it is considered a message to others in her group, who may be forced to watch the assault. The perpetrators of genocidal rape attempt to maximize suffering and trauma, in order to cause the highest level of damage to the survivor and her community (WHO, 2002).
The degree to which survivor mental health is affected by sexual assault trauma varies by severity, type, frequency, degree of physical injury and perceived threat to life, as well as whether the survivor received medical or mental health intervention after the incident (Allen, 2003; Draijer & Langeland, 1999; Golding, Wilsnack, & Cooper, 2002; Wasco, 2003). The biological outcome of rape may influence the severity of psychological symptoms: rape without impregnation, rape resulting in pregnancy, and pregnancies followed by abortions or by childbirth resulted in differing levels of emotional trauma for survivors (Fischman, 1996; Kozaric-Kovacic, Folnegovic-Smalc & Skrinjaric, 1993). Pregnancy followed by childbirth was associated with the most severe levels of distress (Fischman, 1996, p. 161; Kozaric-Kovacic, Folnegovic-Smalc & Skrinjaric, 1993).
Increasingly severe levels of impairment may develop from the combination of sexual assault and a “lifetime history of multiple traumas” (Allen, 2003, p. 213). The intersections of gender, class, ethnicity, and previous victimization history, and exposure to a “pervasive toxic culture” that condones violence against women, may increase the traumatic response (Brownmiller, 1994; Cahill, 2001; Stiglmeyer, 1994; Wasco, 2003, p. 318). Individual and contextual factors such as genetics, resilience, and social support may mediate the development of psychological problems following exposure to trauma (Epstein, 1997; Messman-Moore, 2000).
Dissociation, psychotic symptoms, sexual dysfunction and self-harming behaviors are commonly reported by survivors (Allen, 2003; Draijer & Langeland, 1999; Messman-Moore & Long, 2000). Sexual abuse has been associated with the development of borderline personality disorder or complex PTSD (Allen, 2003; American Psychiatric Association, APA, 2000). Elevated levels of substance abuse, depression, eating disorders, and anxiety have been noted (DeLillo & Damashek, 2003; Messman-Moore & Long, 2000). Survivors are also likely to experience other types of psychological distress, including low self-esteem and self-worth, feelings of objectification, guilt, and self-blame (Kulkoski, 1997; Messman-Moore, 2000; Wasco, 2003).
While the sequelae of sexual assault are “shaped by the particular social and cultural context in which the rape occurs,” one of the persistent features of rape survivors is the development of these reexperiencing, avoidant, and arousal responses to posttraumatic reminders of the event (APA, 2000; Association, 2000; Herman, 1992; Stover, 2005; Swiss, 1993). Descriptions of PTSD demonstrate how “the contradictory responses of intrusion and constriction establish an oscillating rhythm. This dialectic of opposing psychological states is perhaps the most characteristic feature of posttraumatic syndromes” (Herman, 1992, p. 42). If these symptoms occur during or immediately following the trauma, the survivor could be diagnosed with an Acute Stress Disorder (APA, 2000). If the symptoms persist longer than 1 month, a diagnosis of posttraumatic stress disorder (PTSD) may be appropriate (APA, 2000).
Survivors of rape often report “reexperiencing” symptoms such as intrusive memories or dreams of the event or the perpetrator (APA, 2000; Stover, 2005). Avoidant tendencies, including emotional numbing, detachment, depersonalization, derealization and amnesia, are frequently reported by sexual assault survivor (Allen, 1996; Allen, 2003; DiLillo, 2000; Draijer, 1999). Arousal symptoms include heightened psychological distress, physiologic arousal, and hypervigilance (Allen, 2003; APA, 2000). Chronic sleep disturbance including insomnia, nightmares and nocturnal awakenings are common, especially if the survivor associates nighttime, being asleep, or being in the bedroom with the assault (Allen, 2003; APA, 2000). The survivor may vividly relive the assault while sleeping, experienced through frightening and upsetting dreams, which may be unsettling for family members, particularly children (Herman, 1992).
Survivors of sexual assault comprise the largest group of individuals currently diagnosed with PTSD (APA, 2000). Rape is among the most salient PTSD risk factors (Allen, 2003, p. 213; DiLillo, Tremblay, & Peterson, 2000; Draijer & Langeland, 1999). It is reported that one in four women who had been raped said four to six years after the rape that she still had not recovered (Stover, 2005).
The American Psychiatric Association notes that “survivors of rape, military combat and captivity, and ethnically or politically motivated internment and genocide” were found to have the highest rates of posttraumatic stress disorder (APA, 2000). People who endure repeated, prolonged trauma or imprisonment are particularly vulnerable to the development of intrusive symptoms that may linger for decades after the experiences, as demonstrated with groups of Korean War prisoner and survivors of Nazi concentrations camps (Stover, 2005).
Many of the women described in the case studies of Bosnia, Rwanda, and Darfur could fit in to all of these risk categories, so they are extremely vulnerable to developing posttraumatic stress disorder (PTSD). Not surprisingly, PTSD has been prevalent among rape survivors in Darfur, Rwanda, and Bosnia-Hercegovina. Physicians for Human Rights reported that PTSD is common in rape survivors in Darfur, and noted that posttraumatic stress can result in depression, anxiety, nightmares, difficulty sleeping, social phobias, and physical complaints (Allen, 2003; PHR, 2006; WHO, 2002).
Witnesses to rape and torture may also develop posttraumatic symptoms or PTSD, particularly if they have a relationship with the survivor/victim or the perpetrator. The terrorizing effects of rape are often exploited when perpetrators force family members or others to witness acts of sexual violence and torture (Boose, 2001; Swiss & Giller, 1993). For a diagnosis of PTSD, the person may have “witnessed or been confronted by a traumatic event,” without directly experiencing a threat to oneself (Association, 2000).
Public rape was regularly used in Bosnia-Hercegovina as an act of community intimidation because “the psychiatric consequences in [witnesses] can be very pronounced, sometimes even greater than in primary victims” of rape (Zalihic-Kaurin, 1994, p. 171). Rapes committed “in front of the victim’s immediate family—children, parents, husband—result in severe trauma” for the survivor and the witnesses (Folnegovic-Smalc, 1994, p. 175). Family members may have varying responses to witnessing rape, and they would sometimes cast out the survivors and any children born of rape because they reminded the witnesses of the collective trauma inflicted on the community.
Rape (especially excessively brutal and public rape) causes survivors, witnesses, and other community or family members to leave their homelands Hilsum, 2004). Bosnian women were raped in public in order to “spread fear and induce the flight of” non-Serb inhabitants of contested lands (Stiglmayer, 1994, p. 85). It was common for the JNA to enter a village and rape every girl and woman in succession, from the youngest child to the most elderly grandmother (MacKinnon, 1994, p. 190). Survivors and witnesses do not wish to return to the scene of the crime, and so maximizing trauma in the target population through public displays of brutal sexual violence leads to mass fleeing from areas of contested territory. After the genocides ended in Bosnia and Rwanda, some perpetrators have continued brutalizing their past victims, and many survivors are simply too afraid to return to their homes because of what they experienced and/or witnessed there (Stover, 2005). Others have relocated back to the areas where the crimes occurred, and report difficulties with traumatic reminders on a frequent basis.
Public rapes are common in Darfur, with family members and/or the wider community witnessing the rape and torture. Anyone who intervenes may be beaten, stabbed, or killed. The rape survivor may feel betrayed by the witnesses for not protecting her. Those who witnessed and did not defend the raped woman may feel ashamed, which they may express as aversion, anger, or even hatred toward the survivor. Exposing the community and family to the rape of women magnifies the intensity and complexity of the traumatic response, while exponentially increasing the number of survivors who may be psychologically impacted by these events (WHO, 2002).
A survivor may experience dramatic mood swings or changes in personality due to the profound sense of loss and grief that they experience, and these changes can be very upsetting for family members and friends, who may withdraw from the survivor in the aftermath of these difficult mood swings or negative encounters. Sometimes the family members, friends, or neighbors of the survivor do not understand or comprehend the magnitude of the assault’s impact on the survivor (Stover, 2005). This lack of understanding or awareness of the traumatic response by friends and family can make the survivor feel isolated and misunderstood (Herman, 1992; Stover, 2005). Because of the impact these symptoms have on their social functioning and the reactions of others to their changed behaviors, survivors with PTSD may have “difficulty reestablishing intimate relationships” after the violence (Swiss & Giller, 1993, p. 614).
Sexual assault is associated with “increased difficulties across several domains of interpersonal functioning” (DiLillo, Tremblay, & Peterson, 2000, p. 768; Chen & Kaplan, 2001; DeLillo & Damashek, 2003). Survivors tend to report smaller support networks, more social isolation, and less emotional support than other women (Chen, 2001; Golding, 2002). Survivors often report difficulty establishing and maintaining trusting relationships after the rape, and this difficulty with trust may manifest itself in social isolation or self-harming behaviors (DiLillo, 2000).
Within the realm of romantic and sexual relationships, this lack of trust can be particularly problematic (Golding, 2002). Clinicians have reported that survivors of mass rape may consider “all male persons [to be] identified with torturers” and rapists (Kozaric-Kovacic, 1993). Sexuality may be perceived as a threatening reminder of a brutal victimization, and the survivor may be unwilling or unable to have sex with her husband or partner. One survivor, whose perspective echoed many others, reported, “for me there’s not such thing as sex anymore; that’s all in my past” (Folnegovic-Smalc, 1995, p. 177).
PTSD symptoms may decrease or eliminate interest and participation in sex, which can cause difficulties in intimate relationships. Sexual trauma in particular may lead to “an aversion to sexuality” in both survivors and witnesses of rape (Cahill, 2001; Folnegovic-Smalc, 1994, p. 177). “Aversion to sexuality” is not a desired characteristic for wives in most cultures, so this may place survivors at risk for rejection by current or prospective spouses. Decreased interest and participation in sex also reduces the likelihood that the woman will give birth to children within her community. Through these social means, the psychosocial consequences of rape can have practical and long-term population reductive effects (WHO, 2002).
The trauma of rape may prevent the survivor from assimilating back in to her previous roles in her family or society. Serbs made “deliberate use of this social information” as they perpetrated genocide. Rapes were designed to maximize trauma to the survivors, witnesses, and the targeted community as a whole (Turshen, 2000, p. 803). Rapes were “intended to disable an enemy by destroying the bonds of family and society” through the perpetration of trauma and stigma (Swiss & Giller, 1993, 613).
To avoid the stigma associated with rape, survivors may attempt to conceal the assault from public awareness. Three adolescent survivors in Darfur attempted to conceal the rapes by telling neighbors about the Janjawid attack, without mentioning the sexual assaults. Assumptions and gossip spread. It was clear that neighbors knew the girls had been raped, because they changed their treatment of the girls. One of the survivors told a journalist that when people discover a woman has been raped, "They scorn you. They laugh at you… They look at you as if you are strange, as if they haven't seen you before" (Timberg, 2006).
The perpetrators of genocidal rape use their knowledge of the social consequences of sexual assault to maximize damage to the target population. Rapes are conducted in such a way that they are difficult for victims to conceal, such as rapes in public and in broad daylight. Women who are clearly pregnant have no chance to hide what happened to them, and this is one of the intentions of forced pregnancy: to compel the woman to suffer the stigma her community deems appropriate for a rape survivor.
Survivors and children of rape remind the family and community of their collective defeat, which can be both demoralizing and terrifying. The family or community may cast the woman or child out, abuse them further, or even kill them (Amnesty International, 2004; Turshen, 2004). This causes deeper emotional damage for all involved and tears at the fabric that holds families and the community together. Perpetrators of genocidal rape intentionally continue population-reducing effects over time by using the social stigma of rape to render a generation of childbearing women unlikely to do so (Turshen, 2000).
In Rwanda, Darfur, and Bosnia-Hercegovina, survivors or rape are generally not considered acceptable wives. Survivors may be cast out if they are married at the time of the assault, especially if injuries affect reproductive capacities. Care of the children and the household is the sole responsibility of women in these cultures, and injured or traumatized women are considered less valuable as wives (Amnesty International, 2004). One Darfuri survivor described how excited she had been about her engagement until she was raped; her fiancé said he would not marry her because she was “disgraced and spoilt” [sic] (Duroch, 2005). The survivor said, “It is the worse thing for me” (Duroch, 2005).
The stigma of rape is a crushing burden because of the associated social and economic disadvantages. Unmarried women do not have the financial and physical protection that married women do in the Sudan, Darfur, and Bosnia-Hercegovina, and this places survivors at further risk for abuse and starvation. Because of the widespread sexual assaults of young women and girls, families in Darfur worry that they cannot protect their young women’s sexual virtue, upon which their basic safety depends.
As a result, parents attempt to marry off their daughters early in order to preserve the family honor. The “bride price” in the internally displaced persons camps has decreased to the point where families will marry their daughters to anyone who can scrape together minimal compensation for the family. This exposes young women and girls to potentially abusive spouses, early sexual intercourse (with the husband), and young marriage with few choices. Since marriage is technically no protection against rape, early marriage of daughters may not ultimately protect the family honor if the daughters are raped after marriage and subsequently left by their husbands, which is the common practice.
In the Bosnian wars, the Serb forces made use of cultural information about women’s roles to maximize the impact of the psychosocial trauma of rape. It is known that a Bosnian husband would divorce his wife if she were raped, and an unmarried raped woman would not be considered eligible for marriage (Stiglmayer, 1994). ). Regardless of their utter lack of complicity in their sexual victimization, “wartime rape victims’ husbands held their wives responsible for the deed or ended their relationships because of the rape” (Seifert, 1994, p. 59). A Muslim physician in Bosnia, reported, “if a man has even the slightest suspicion that his wife may have cooperated voluntarily, the marriage is over;” many Bosnian men acknowledge that they would abandon a wife even if she had not cooperated with the perpetrators (Stiglmayer, 1994, p. 91). These social rejections of rape survivors have long-term reductive effects on population over time.
“Women hold communities together, and attacking them contributes to the defeat and disintegration in a number of ways” including the collapse of community structures beginning with the most basic family unit (MacDonald, 2003, p. 1). The trauma of rape can cause pervasive problems that may prevent the survivor from assimilating back in to her family or society as a functional and productive member, so women become “prime targets because of their cultural position and their importance in the family structure” (Seifert, 1994, p. 63).
In these ways, rape leads directly to the destruction of family and community structures that is the ultimate goal of genocide. The men, especially the victim’s father, husband, or brothers, may feel that they failed to protect the victim, they may feel humiliated when they see the victim. Survivors of rape broadcast a message of defeat to the family and community of the victimized woman, which can both demoralize and terrify them. They may cast the survivor out or abuse her further, causing deeper emotional trauma and tearing at the fabric that holds the family and the community together.
“Memories of wartime atrocities, like all memories, are local; they are embedded in the psyche of individual victims and witnesses and, through the process of retelling and memorialization, they are deposited in the collective memory of the community” (Stover, 2005, p. 143). Rape survivors and the children born of rape evoke these memories for the community, and the community’s desire to avoid or exclude survivors may be partially in an attempt to shield itself from the reminder of the cultural defeat, and the internalization of the assault of its members as an assault on the community. The experiences of individual women are magnified and become applicable to the whole population through these processes of collective memory, deterioration of family and social structures, and the internalization of the assault against the community by its members.
The World Health Organization (2002) lists anxiety, anger, shame, depression, post-traumatic stress, and suicide as potential psychological consequences of sexual violence. However, it must be acknowledged that even the “terms by which psychology understands the word rape are rendered grossly insufficient, if not meaningless by the experiences” of mass rape survivors in Darfur, Rwanda, and Bosnia-Hercegovina because of the level of compound traumas these women have suffered (Boose, 2002, p. 71).
Genocidal rape survivors have been exposed to “interactive traumatic stressors;” they have been emotionally and physically impacted in ways that psychology is not prepared to handle (Fischman, 1996, p. 161). These additional traumas can include detention in rape camps, forced pregnancy, death of loved ones, threat to survival, torture, war-related illnesses or injuries, “loss of home and community,” “stresses of migration and dislocation, cultural shock, lack of familiar support systems, and fear of deportation” (Fischman, 1996, p. 161). The victim’s sense of structure and safety may have been shattered by the compound traumas she has experienced. Rapes may be combined with physical abuse and torture, starvation, verbal abuse, and other forms of domination and humiliation in order to maximize the trauma to the survivor. Weapons such as guns, axes, and whips were commonly used to intimidate and threaten the women in Darfur, while machetes and AK-47s were wielded in Rwanda. It has been shown that these techniques often increase the intensity of the traumatic response (Physicians for Human Rights, PHR, 2006).
The survivor’s psychological response may be influenced by the context and level of brutality of the assault. Rapists often used dehumanizing epithets and racialized or gendered slurs directed at the raped woman and her community. In Daufur, “slave” and “black slave” are common ways the perpetrators refer to African women from the Fur, Masalit and Zaghawa ethnic groups (Wax, 2004). In Bosnia-Hercegovina, women were commonly called “Turks” or “Ustasha whores” (Boose, 2002). This form of ethnically oriented verbal abuse increases the suffering of the raped woman, and it is considered a message to others in her group, who may be forced to watch the assault. The perpetrators of genocidal rape attempt to maximize suffering and trauma, in order to cause the highest level of damage to the survivor and her community (WHO, 2002).
The degree to which survivor mental health is affected by sexual assault trauma varies by severity, type, frequency, degree of physical injury and perceived threat to life, as well as whether the survivor received medical or mental health intervention after the incident (Allen, 2003; Draijer & Langeland, 1999; Golding, Wilsnack, & Cooper, 2002; Wasco, 2003). The biological outcome of rape may influence the severity of psychological symptoms: rape without impregnation, rape resulting in pregnancy, and pregnancies followed by abortions or by childbirth resulted in differing levels of emotional trauma for survivors (Fischman, 1996; Kozaric-Kovacic, Folnegovic-Smalc & Skrinjaric, 1993). Pregnancy followed by childbirth was associated with the most severe levels of distress (Fischman, 1996, p. 161; Kozaric-Kovacic, Folnegovic-Smalc & Skrinjaric, 1993).
Increasingly severe levels of impairment may develop from the combination of sexual assault and a “lifetime history of multiple traumas” (Allen, 2003, p. 213). The intersections of gender, class, ethnicity, and previous victimization history, and exposure to a “pervasive toxic culture” that condones violence against women, may increase the traumatic response (Brownmiller, 1994; Cahill, 2001; Stiglmeyer, 1994; Wasco, 2003, p. 318). Individual and contextual factors such as genetics, resilience, and social support may mediate the development of psychological problems following exposure to trauma (Epstein, 1997; Messman-Moore, 2000).
Dissociation, psychotic symptoms, sexual dysfunction and self-harming behaviors are commonly reported by survivors (Allen, 2003; Draijer & Langeland, 1999; Messman-Moore & Long, 2000). Sexual abuse has been associated with the development of borderline personality disorder or complex PTSD (Allen, 2003; American Psychiatric Association, APA, 2000). Elevated levels of substance abuse, depression, eating disorders, and anxiety have been noted (DeLillo & Damashek, 2003; Messman-Moore & Long, 2000). Survivors are also likely to experience other types of psychological distress, including low self-esteem and self-worth, feelings of objectification, guilt, and self-blame (Kulkoski, 1997; Messman-Moore, 2000; Wasco, 2003).
Acute and Posttraumatic Stress Disorders
The diagnosis of posttraumatic stress disorder (PTSD) was adopted in 1980 to describe the condition of Vietnam veterans, who reported great psychological distress, long after the traumatic events causing the distress had ceased (Douglas, 2001; Stover, 2005, p. 25). One specific causal factor of PTSD is exposure to a traumatic stressor so severe that it “would evoke significant symptoms of distress in almost everyone” and that is “generally outside the range of human experience” (Douglas, 2001, p. 2; Stover, 2005). The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, 2000), published by the American Psychiatric Association (APA) lists the essential components of acute or posttraumatic stress disorder. The most essential feature of actue or posttraumatic stress is exposure to a traumatic event in which the “person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others” (APA, 2000, p. 467). Additionally, the person’s response to the experience or event must have involved “intense fear, helplessness, or horror” in order to qualify for a diagnosis of acute or posttraumatic stress disorder (Association, 2000, p. 467).While the sequelae of sexual assault are “shaped by the particular social and cultural context in which the rape occurs,” one of the persistent features of rape survivors is the development of these reexperiencing, avoidant, and arousal responses to posttraumatic reminders of the event (APA, 2000; Association, 2000; Herman, 1992; Stover, 2005; Swiss, 1993). Descriptions of PTSD demonstrate how “the contradictory responses of intrusion and constriction establish an oscillating rhythm. This dialectic of opposing psychological states is perhaps the most characteristic feature of posttraumatic syndromes” (Herman, 1992, p. 42). If these symptoms occur during or immediately following the trauma, the survivor could be diagnosed with an Acute Stress Disorder (APA, 2000). If the symptoms persist longer than 1 month, a diagnosis of posttraumatic stress disorder (PTSD) may be appropriate (APA, 2000).
Survivors of rape often report “reexperiencing” symptoms such as intrusive memories or dreams of the event or the perpetrator (APA, 2000; Stover, 2005). Avoidant tendencies, including emotional numbing, detachment, depersonalization, derealization and amnesia, are frequently reported by sexual assault survivor (Allen, 1996; Allen, 2003; DiLillo, 2000; Draijer, 1999). Arousal symptoms include heightened psychological distress, physiologic arousal, and hypervigilance (Allen, 2003; APA, 2000). Chronic sleep disturbance including insomnia, nightmares and nocturnal awakenings are common, especially if the survivor associates nighttime, being asleep, or being in the bedroom with the assault (Allen, 2003; APA, 2000). The survivor may vividly relive the assault while sleeping, experienced through frightening and upsetting dreams, which may be unsettling for family members, particularly children (Herman, 1992).
Survivors of sexual assault comprise the largest group of individuals currently diagnosed with PTSD (APA, 2000). Rape is among the most salient PTSD risk factors (Allen, 2003, p. 213; DiLillo, Tremblay, & Peterson, 2000; Draijer & Langeland, 1999). It is reported that one in four women who had been raped said four to six years after the rape that she still had not recovered (Stover, 2005).
The American Psychiatric Association notes that “survivors of rape, military combat and captivity, and ethnically or politically motivated internment and genocide” were found to have the highest rates of posttraumatic stress disorder (APA, 2000). People who endure repeated, prolonged trauma or imprisonment are particularly vulnerable to the development of intrusive symptoms that may linger for decades after the experiences, as demonstrated with groups of Korean War prisoner and survivors of Nazi concentrations camps (Stover, 2005).
Many of the women described in the case studies of Bosnia, Rwanda, and Darfur could fit in to all of these risk categories, so they are extremely vulnerable to developing posttraumatic stress disorder (PTSD). Not surprisingly, PTSD has been prevalent among rape survivors in Darfur, Rwanda, and Bosnia-Hercegovina. Physicians for Human Rights reported that PTSD is common in rape survivors in Darfur, and noted that posttraumatic stress can result in depression, anxiety, nightmares, difficulty sleeping, social phobias, and physical complaints (Allen, 2003; PHR, 2006; WHO, 2002).
Witnesses to rape and torture may also develop posttraumatic symptoms or PTSD, particularly if they have a relationship with the survivor/victim or the perpetrator. The terrorizing effects of rape are often exploited when perpetrators force family members or others to witness acts of sexual violence and torture (Boose, 2001; Swiss & Giller, 1993). For a diagnosis of PTSD, the person may have “witnessed or been confronted by a traumatic event,” without directly experiencing a threat to oneself (Association, 2000).
Public rape was regularly used in Bosnia-Hercegovina as an act of community intimidation because “the psychiatric consequences in [witnesses] can be very pronounced, sometimes even greater than in primary victims” of rape (Zalihic-Kaurin, 1994, p. 171). Rapes committed “in front of the victim’s immediate family—children, parents, husband—result in severe trauma” for the survivor and the witnesses (Folnegovic-Smalc, 1994, p. 175). Family members may have varying responses to witnessing rape, and they would sometimes cast out the survivors and any children born of rape because they reminded the witnesses of the collective trauma inflicted on the community.
Traumatic Reminders Cause Fleeing
One of the hallmark features of PTSD is the tendency to avoid reminders of the traumatic event, such as places, people, and things that are associated with the trauma. Survivors and witnesses of rape have a tendency to avoid the location where the rape occurred (Zalihic-Kaurin, 1994). The perpetrators of these rapes used the common knowledge that people tend to avoid places where terrible things have happened to them in order to encourage fleeing from areas of contested territory. In this way, rape can be used “as an instrument of forced exile” to drive the population from certain areas (MacKinnon, 1994, p. 190). In each conflict presented, the perpetrators purposely maximized the level of trauma to victims and witnesses in order to disperse the civilian population. When perpetrated on a mass scale as in these conflicts, the “terrorism of rape … forces entire communities into flight,” serving the goals of genocide and ethnic cleansing (Swiss & Giller, 1993).Rape (especially excessively brutal and public rape) causes survivors, witnesses, and other community or family members to leave their homelands Hilsum, 2004). Bosnian women were raped in public in order to “spread fear and induce the flight of” non-Serb inhabitants of contested lands (Stiglmayer, 1994, p. 85). It was common for the JNA to enter a village and rape every girl and woman in succession, from the youngest child to the most elderly grandmother (MacKinnon, 1994, p. 190). Survivors and witnesses do not wish to return to the scene of the crime, and so maximizing trauma in the target population through public displays of brutal sexual violence leads to mass fleeing from areas of contested territory. After the genocides ended in Bosnia and Rwanda, some perpetrators have continued brutalizing their past victims, and many survivors are simply too afraid to return to their homes because of what they experienced and/or witnessed there (Stover, 2005). Others have relocated back to the areas where the crimes occurred, and report difficulties with traumatic reminders on a frequent basis.
Public rapes are common in Darfur, with family members and/or the wider community witnessing the rape and torture. Anyone who intervenes may be beaten, stabbed, or killed. The rape survivor may feel betrayed by the witnesses for not protecting her. Those who witnessed and did not defend the raped woman may feel ashamed, which they may express as aversion, anger, or even hatred toward the survivor. Exposing the community and family to the rape of women magnifies the intensity and complexity of the traumatic response, while exponentially increasing the number of survivors who may be psychologically impacted by these events (WHO, 2002).
Social Consequences of PTSD
Survivors of sexual assault often experience social problems, which may be related to the psychological trauma of rape. Some of the symptoms of PTSD have an impact of the survivor’s ability to relate socially. Among the symptoms listed as criteria for a PTSD diagnosis are: “feelings of detachment or estrangement from others,” “markedly diminished interest or participation in significant activities,” “restricted affect,” “a sense of foreshortened future,” “irritability or outbursts of anger,” and “hypervigilence” (APA, 2000, p. 468).A survivor may experience dramatic mood swings or changes in personality due to the profound sense of loss and grief that they experience, and these changes can be very upsetting for family members and friends, who may withdraw from the survivor in the aftermath of these difficult mood swings or negative encounters. Sometimes the family members, friends, or neighbors of the survivor do not understand or comprehend the magnitude of the assault’s impact on the survivor (Stover, 2005). This lack of understanding or awareness of the traumatic response by friends and family can make the survivor feel isolated and misunderstood (Herman, 1992; Stover, 2005). Because of the impact these symptoms have on their social functioning and the reactions of others to their changed behaviors, survivors with PTSD may have “difficulty reestablishing intimate relationships” after the violence (Swiss & Giller, 1993, p. 614).
Sexual assault is associated with “increased difficulties across several domains of interpersonal functioning” (DiLillo, Tremblay, & Peterson, 2000, p. 768; Chen & Kaplan, 2001; DeLillo & Damashek, 2003). Survivors tend to report smaller support networks, more social isolation, and less emotional support than other women (Chen, 2001; Golding, 2002). Survivors often report difficulty establishing and maintaining trusting relationships after the rape, and this difficulty with trust may manifest itself in social isolation or self-harming behaviors (DiLillo, 2000).
Within the realm of romantic and sexual relationships, this lack of trust can be particularly problematic (Golding, 2002). Clinicians have reported that survivors of mass rape may consider “all male persons [to be] identified with torturers” and rapists (Kozaric-Kovacic, 1993). Sexuality may be perceived as a threatening reminder of a brutal victimization, and the survivor may be unwilling or unable to have sex with her husband or partner. One survivor, whose perspective echoed many others, reported, “for me there’s not such thing as sex anymore; that’s all in my past” (Folnegovic-Smalc, 1995, p. 177).
PTSD symptoms may decrease or eliminate interest and participation in sex, which can cause difficulties in intimate relationships. Sexual trauma in particular may lead to “an aversion to sexuality” in both survivors and witnesses of rape (Cahill, 2001; Folnegovic-Smalc, 1994, p. 177). “Aversion to sexuality” is not a desired characteristic for wives in most cultures, so this may place survivors at risk for rejection by current or prospective spouses. Decreased interest and participation in sex also reduces the likelihood that the woman will give birth to children within her community. Through these social means, the psychosocial consequences of rape can have practical and long-term population reductive effects (WHO, 2002).
The trauma of rape may prevent the survivor from assimilating back in to her previous roles in her family or society. Serbs made “deliberate use of this social information” as they perpetrated genocide. Rapes were designed to maximize trauma to the survivors, witnesses, and the targeted community as a whole (Turshen, 2000, p. 803). Rapes were “intended to disable an enemy by destroying the bonds of family and society” through the perpetration of trauma and stigma (Swiss & Giller, 1993, 613).
Stigma of Rape
Rape is considered shameful in many cultures, and the survivor is often shunned or punished for being raped (WHO, 2002). A woman’s sexual virtue is highly valued by the community as a marker of the purity and prestige of her family. Being raped means that she has been “spoiled” and reflects poorly upon herself and her family. One survivor said, "after rape, you don't have value in the community” (Human Rights Watch, 1996).To avoid the stigma associated with rape, survivors may attempt to conceal the assault from public awareness. Three adolescent survivors in Darfur attempted to conceal the rapes by telling neighbors about the Janjawid attack, without mentioning the sexual assaults. Assumptions and gossip spread. It was clear that neighbors knew the girls had been raped, because they changed their treatment of the girls. One of the survivors told a journalist that when people discover a woman has been raped, "They scorn you. They laugh at you… They look at you as if you are strange, as if they haven't seen you before" (Timberg, 2006).
The perpetrators of genocidal rape use their knowledge of the social consequences of sexual assault to maximize damage to the target population. Rapes are conducted in such a way that they are difficult for victims to conceal, such as rapes in public and in broad daylight. Women who are clearly pregnant have no chance to hide what happened to them, and this is one of the intentions of forced pregnancy: to compel the woman to suffer the stigma her community deems appropriate for a rape survivor.
Survivors and children of rape remind the family and community of their collective defeat, which can be both demoralizing and terrifying. The family or community may cast the woman or child out, abuse them further, or even kill them (Amnesty International, 2004; Turshen, 2004). This causes deeper emotional damage for all involved and tears at the fabric that holds families and the community together. Perpetrators of genocidal rape intentionally continue population-reducing effects over time by using the social stigma of rape to render a generation of childbearing women unlikely to do so (Turshen, 2000).
In Rwanda, Darfur, and Bosnia-Hercegovina, survivors or rape are generally not considered acceptable wives. Survivors may be cast out if they are married at the time of the assault, especially if injuries affect reproductive capacities. Care of the children and the household is the sole responsibility of women in these cultures, and injured or traumatized women are considered less valuable as wives (Amnesty International, 2004). One Darfuri survivor described how excited she had been about her engagement until she was raped; her fiancé said he would not marry her because she was “disgraced and spoilt” [sic] (Duroch, 2005). The survivor said, “It is the worse thing for me” (Duroch, 2005).
The stigma of rape is a crushing burden because of the associated social and economic disadvantages. Unmarried women do not have the financial and physical protection that married women do in the Sudan, Darfur, and Bosnia-Hercegovina, and this places survivors at further risk for abuse and starvation. Because of the widespread sexual assaults of young women and girls, families in Darfur worry that they cannot protect their young women’s sexual virtue, upon which their basic safety depends.
As a result, parents attempt to marry off their daughters early in order to preserve the family honor. The “bride price” in the internally displaced persons camps has decreased to the point where families will marry their daughters to anyone who can scrape together minimal compensation for the family. This exposes young women and girls to potentially abusive spouses, early sexual intercourse (with the husband), and young marriage with few choices. Since marriage is technically no protection against rape, early marriage of daughters may not ultimately protect the family honor if the daughters are raped after marriage and subsequently left by their husbands, which is the common practice.
In the Bosnian wars, the Serb forces made use of cultural information about women’s roles to maximize the impact of the psychosocial trauma of rape. It is known that a Bosnian husband would divorce his wife if she were raped, and an unmarried raped woman would not be considered eligible for marriage (Stiglmayer, 1994). ). Regardless of their utter lack of complicity in their sexual victimization, “wartime rape victims’ husbands held their wives responsible for the deed or ended their relationships because of the rape” (Seifert, 1994, p. 59). A Muslim physician in Bosnia, reported, “if a man has even the slightest suspicion that his wife may have cooperated voluntarily, the marriage is over;” many Bosnian men acknowledge that they would abandon a wife even if she had not cooperated with the perpetrators (Stiglmayer, 1994, p. 91). These social rejections of rape survivors have long-term reductive effects on population over time.
Consequences for Social Structures and Communities
Sexual violence is perpetrated against women during ethnic conflict because women “keep the civilian population functioning” through their role as mothers, wives, and caretakers (Copelon, 1994, p. 207). The suffering inflicted may cause permanent psychological symptoms or social consequences that impact the woman’s ability to relate, work, or care for her children (Amnesty International, 2004). Because large numbers of individual women experienced the deterioration of the familial structures in their lives, the social structures of the community crumbled as more and more individual women became traumatized (MacDonald, 2003, p. 1). Thus the collapse of community structures begins with individual and familial collapse (see Diagram 2).“Women hold communities together, and attacking them contributes to the defeat and disintegration in a number of ways” including the collapse of community structures beginning with the most basic family unit (MacDonald, 2003, p. 1). The trauma of rape can cause pervasive problems that may prevent the survivor from assimilating back in to her family or society as a functional and productive member, so women become “prime targets because of their cultural position and their importance in the family structure” (Seifert, 1994, p. 63).
In these ways, rape leads directly to the destruction of family and community structures that is the ultimate goal of genocide. The men, especially the victim’s father, husband, or brothers, may feel that they failed to protect the victim, they may feel humiliated when they see the victim. Survivors of rape broadcast a message of defeat to the family and community of the victimized woman, which can both demoralize and terrify them. They may cast the survivor out or abuse her further, causing deeper emotional trauma and tearing at the fabric that holds the family and the community together.
“Memories of wartime atrocities, like all memories, are local; they are embedded in the psyche of individual victims and witnesses and, through the process of retelling and memorialization, they are deposited in the collective memory of the community” (Stover, 2005, p. 143). Rape survivors and the children born of rape evoke these memories for the community, and the community’s desire to avoid or exclude survivors may be partially in an attempt to shield itself from the reminder of the cultural defeat, and the internalization of the assault of its members as an assault on the community. The experiences of individual women are magnified and become applicable to the whole population through these processes of collective memory, deterioration of family and social structures, and the internalization of the assault against the community by its members.
MASS RAPE: A SOCIAL WELFARE PROBLEM?
The National Association of Social Workers (NASW) lists service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence as its core ethical values. Social workers are encouraged to aspire to these ideals as detailed in the Code of Ethics (NASW, 2007). The first social work principle is service. NASW states that Social workers' primary goal is to “help people in need and to address social problems” (NASW, 2007). In the aftermath of mass rape, survivors display psychosocial as well as physical problems that need to be addressed.
Social justice, and a commitment to challenge injustice, is another core social work principle (NASW, 2007). Genocide and mass rape are the polar opposite of social justice and human rights, and it is one of social work’s imperatives to advocate for the latter principles. Social workers “pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people” (NASW, 2007). Survivors and witnesses of mass rape are certainly “vulnerable and oppressed,” so the imperatives of social justice for these populations supports a social work response to the problem of mass rape. NASW principles state that social workers “strive to ensure access” to needed services for people experiencing social injustice. The principles of service and social justice have drawn the field’s attention to the social problems caused by mass rape campaigns. NASW has responded to the current crisis in Darfur with advocacy for humanitarian and peace-keeping intervention in the region (NASW, 2006).
Social workers value the dignity and worth of the person as well as human relationships. Sexual violence can cause the loss of personal dignity, integrity, and self-determination (Heise, 1998). Rape can be considered the most severe attack on a woman’s embodied identity, especially in the context of genocide (Seifert, 1994) The struggle for dignity and self-determination is rooted in the control of one’s own body and physical access to one’s own body; these important social work and human rights values are demolished through mass rape (Heise, 1998; Seifert, 1994). The social work profession’s estimation of the inherent worth of human life and the value of human dignity should compel individuals, agencies, and organizations within the social welfare community to respond to these crises. Further research, advocacy, and service development/provision are needed to effectively intervene with survivors and witnesses of mass rape.
The destruction of human relationships, human dignity, and human rights in the aftermath of mass rape is staggering. A social work response to these crises, featuring a relational, strengths-based, systems approach could offer hope for psychosocial recovery and reconstruction of the social structures that sustain individuals, families, and communities. Judith Herman, an expert in the field of violence and trauma, stated “recovery [from psychological trauma] is based on the empowerment of the survivor and the creation of new connections. Recovery can take place only in the context of relationships” (Herman, 1992, p. 133).
Since social workers “seek to strengthen relationships among people in a purposeful effort to promote, restore, maintain, and enhance the well-being of individuals, families, social groups, organizations, and communities,” the social work profession seems ideally suited to respond to the psychosocial needs of traumatized populations left in the wake of mass rape (NASW, 2007). An historic and defining feature of social work is the profession's focus on individual well-being in a social context and the well-being of society, a useful approach when individual lives, families, social and community structures must be rebuilt (Code of Ethics, NASW, 2007).
The social work principle of integrity can be interpreted to mean a refusal to engage in behavior that evades responsibility. NASW explicitly states, “Social workers are continually aware of the profession's mission, values, ethical principles, and ethical standards and practice in a manner consistent with them” (NASW, 2007). The integrity of the social work profession and its members is strengthened by the commitment to the ethical principles and standards delineated in the NASW Code of ethics. The principles and core values of the social work profession dictate that the problem of mass rape is within the scope of the field. In order to uphold the commitment to these core values and preserve the profession’s integrity, an active response of social workers in the provision of services to mass rape survivors is necessary.
In typical practice, social workers regularly respond to incidences of rape and sexual violence. Rape survivors may contact a social worker through a crisis hotline, emergency room, forensic interviewing center, psychiatric or mental health service, gynecological or abortion clinic, women’s center, domestic violence or homeless shelter, HIV testing facility, or counseling agency. The field of social work responds to rape through practice, policy, and research as well as through its advocacy on behalf of survivors, victims, and their families. Social workers may also be involved with treatment or interventions for perpetrators of sexual violence, or with rape prevention programs.
Thus, the “social problem of rape” is easily considered within the realm of social work practice, research, theory, policy, and advocacy. The “social problem of mass rape” falls similarly within the purview of social welfare. Scholars are calling for increased contribution by the field of social welfare to prevention of and response to mass rape, particularly in the context of ethnic conflict and genocide (Alenkin, 2006).
Due to the scope of the physical and emotional devastation left in the wake of genocidal rape campaigns, treatment interventions that victims receive are often only marginally available, accessible, or effective. (Arcel et al, 1995; Frljak et al., 1997; Human Rights Watch, 1996; Kozaric-Kovacic, 1995). Timely, appropriate, and decently funded intervention by the United Nations (UN) or other forces (such as individual countries, coalitions, or independent aid organizations) is the best way to protect civilian women from becoming victims during a mass rape campaign. Many organizations provide treatment and intervention for rape trauma tend to survivors’ basic safety and physical needs, which is essential for their physical survival and their mental health (Arcel et al, 1995; Richters, 1997).
Intervention should include the provision of basic amenities, such as food, water, shelter and security, as well as stationary and mobile health and mental health services. Provision of food, clean water, decent housing or shelter, and reasonable protection from further harm have been established as important components of successful recovery; it is widely agreed that little psychological comforting can be accomplished in the absence of “three hots and a cot” (Arcel et al, 1995; Kozaric-Kovacic, 1993; Sharipova, 1997). The provision of relative security in a war zone or recently demilitarized zone can be complicated, and may require partnering with governmental or other organizations that can provide for the basic security of workers and clients, such as the United Nations.
Survivors often have both health and mental health needs, but they are more likely to seek assistance for physical health problems. In order to reach a greater number of survivors in need of social work services, it will be important to partner with health care providers. Frequently, raped women will seek medical care if it is available to them, but they may not disclose their abuse despite obvious trauma to the genitalia or other clear signs of sexual assault (Fischman, 1996; Swiss & Giller, 1993). Women should be sought out for treatment in ways that are not embarrassing because they are not likely to come forward on their own. In a study of over 100 Ugandan victims of wartime rape, “only half told anyone about the rape despite the fact that they all still had problems related to the rape when they finally spoke of it” (Swiss & Giller, 1993, p. 612). Confidentiality should be strictly observed, and all possible efforts to protect and restore the victim’s pride, self-respect, and image in the community should be made.
Because health care is virtually absent in war and is denied to victims of genocidal rape by virtue of the fact that they are intended to suffer and die, mobile and stationary rape crisis centers with teams able to respond to acute and severe trauma should be mobilized in these areas. The services provided should include physical health care and emergency services including transportation, mental health counseling, abortion, pain management, and evidence collection for later use at trials. Reports of sexual violence should be collected in a more systematic manner, keeping in mind the need for privacy and sensitivity in order to obtain testimony from rape victims. (Human Rights Watch, 1996). Women health care professionals should be included on the teams, because rape survivors overwhelmingly report that they would disclose their abuse to a female, but not a male, examiner or counselor (Human Rights Watch, 1996). These teams would need military or police protection that was trustworthy in order to protect the safety of rape crisis workers in the field. And even then, there is no guarantee of safety for workers in general, and females in particular.
In the aftermath of a genocidal rape campaign, physical and mental health care for victims must be a priority. Victims of sexual abuse during the genocide suffer persistent health problems and generally only receive intermittent, partial or temporary assistance for persistent, all embracing and potentially terminal problems (Frljak et al., 1997; Human Rights Watch, 1996; Kozaric-Kovacic, et al., 1995). Unfortunately the stigma surrounding sexual abuse often dissuades women from seeking the medical assistance they need. Interventions must be made accessible to women in a way that is not perceived as shameful to women and does not call attention to the sexual nature of the crime. Clinics must be established in such a way that it is not obvious what a woman is going in for (i.e. it should not be called a “rape crisis center” and only treat people for that type of problem; it should be a women’s medical facility that also provides quality treatment to survivors of sexual violence). It is essential that mental health service providers collaborate with providers of physical health care for survivors.
Mental health counseling should be available to rape survivors on an ongoing basis for as long as they need it. Survivors of the Rwandan genocide in 1994 reported utilizing rape-counseling services, if the counselor was a woman, and if the services were available to them (African Rights, 2004). In a ten-year follow-up study, survivors accessing mental health counseling had better overall outcomes than those who did not get counseling (there was no difference in access to health care services between the women who has received counseling and those who had not) (African Rights, 2004). Following a mass rape campaign, social work services may be provided to the victimized population, and these services can be extremely varied in terms of scope, focus, and theoretical framework. Individual, small group, large group, and family psychotherapy may be employed (Arcel, 1995; Pierotti, 1997; Webb, 2004). Counseling services may rely upon different theoretical frameworks, including empowerment or client-centered, psychoanalytic, cognitive-behavioral, mixed, or other paradigms (Arcel et al, 1995). In the field of mass crisis response, often counseling focuses on practical strategies for coping with the trauma that they have suffered and moving on with their lives (Arcel et al, 1995; Webb, 2004).
It is especially important to advocate for strengths based services, because of the humiliation and demoralization that genocidal rape survivors face. When staggering numbers of women are severely traumatized at once through mass rape campaigns, the strengths approach is particularly appropriate because it highlights existing abilities, beneficial qualities, and other positive factors that may assist in the recovery process. Social welfare is a leader among other professions, fields, and disciplines in the application of a strengths perspective to problem solving. Social workers help their clients solve problems, reach psychosocial goals, and facilitate positive human relationships through a strengths approach. A direct social work response to mass rape could provide valuable assistance to survivors as they rebuild their mental health, social networks, economic stability, and return to their lives.
The social work profession is uniquely suited to respond to the problems of mass rape because of historic, ideological, and pragmatic factors. The field is well versed in the psychology, sociology, and the politics of rape, as well as medical, psychiatric, and forensic responses to sexual violence. The strengths perspective combined with the pragmatism of social work’s approach to understanding and solving problems could be applied in the aftermath of mass rape to aid in the recovery of traumatized individuals, families, and communities.
Social justice, and a commitment to challenge injustice, is another core social work principle (NASW, 2007). Genocide and mass rape are the polar opposite of social justice and human rights, and it is one of social work’s imperatives to advocate for the latter principles. Social workers “pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people” (NASW, 2007). Survivors and witnesses of mass rape are certainly “vulnerable and oppressed,” so the imperatives of social justice for these populations supports a social work response to the problem of mass rape. NASW principles state that social workers “strive to ensure access” to needed services for people experiencing social injustice. The principles of service and social justice have drawn the field’s attention to the social problems caused by mass rape campaigns. NASW has responded to the current crisis in Darfur with advocacy for humanitarian and peace-keeping intervention in the region (NASW, 2006).
Social workers value the dignity and worth of the person as well as human relationships. Sexual violence can cause the loss of personal dignity, integrity, and self-determination (Heise, 1998). Rape can be considered the most severe attack on a woman’s embodied identity, especially in the context of genocide (Seifert, 1994) The struggle for dignity and self-determination is rooted in the control of one’s own body and physical access to one’s own body; these important social work and human rights values are demolished through mass rape (Heise, 1998; Seifert, 1994). The social work profession’s estimation of the inherent worth of human life and the value of human dignity should compel individuals, agencies, and organizations within the social welfare community to respond to these crises. Further research, advocacy, and service development/provision are needed to effectively intervene with survivors and witnesses of mass rape.
The destruction of human relationships, human dignity, and human rights in the aftermath of mass rape is staggering. A social work response to these crises, featuring a relational, strengths-based, systems approach could offer hope for psychosocial recovery and reconstruction of the social structures that sustain individuals, families, and communities. Judith Herman, an expert in the field of violence and trauma, stated “recovery [from psychological trauma] is based on the empowerment of the survivor and the creation of new connections. Recovery can take place only in the context of relationships” (Herman, 1992, p. 133).
Since social workers “seek to strengthen relationships among people in a purposeful effort to promote, restore, maintain, and enhance the well-being of individuals, families, social groups, organizations, and communities,” the social work profession seems ideally suited to respond to the psychosocial needs of traumatized populations left in the wake of mass rape (NASW, 2007). An historic and defining feature of social work is the profession's focus on individual well-being in a social context and the well-being of society, a useful approach when individual lives, families, social and community structures must be rebuilt (Code of Ethics, NASW, 2007).
The social work principle of integrity can be interpreted to mean a refusal to engage in behavior that evades responsibility. NASW explicitly states, “Social workers are continually aware of the profession's mission, values, ethical principles, and ethical standards and practice in a manner consistent with them” (NASW, 2007). The integrity of the social work profession and its members is strengthened by the commitment to the ethical principles and standards delineated in the NASW Code of ethics. The principles and core values of the social work profession dictate that the problem of mass rape is within the scope of the field. In order to uphold the commitment to these core values and preserve the profession’s integrity, an active response of social workers in the provision of services to mass rape survivors is necessary.
In typical practice, social workers regularly respond to incidences of rape and sexual violence. Rape survivors may contact a social worker through a crisis hotline, emergency room, forensic interviewing center, psychiatric or mental health service, gynecological or abortion clinic, women’s center, domestic violence or homeless shelter, HIV testing facility, or counseling agency. The field of social work responds to rape through practice, policy, and research as well as through its advocacy on behalf of survivors, victims, and their families. Social workers may also be involved with treatment or interventions for perpetrators of sexual violence, or with rape prevention programs.
Thus, the “social problem of rape” is easily considered within the realm of social work practice, research, theory, policy, and advocacy. The “social problem of mass rape” falls similarly within the purview of social welfare. Scholars are calling for increased contribution by the field of social welfare to prevention of and response to mass rape, particularly in the context of ethnic conflict and genocide (Alenkin, 2006).
RESPONSE TO THE PROBLEM OF MASS RAPE
Although social workers are involved at the individual or micro level with local interventions for rape such as rape crisis response or counseling, it is important for the field to expand the scope of its response to the problem of mass rape. According to the NASW principle of competence, social workers must “practice within the scope of their abilities and seek to develop and enhance their expertise,” so the field should prepare itself to provide competent services to these populations (NASW, 2007). There must be further development of social work interventions to ensure the delivery of psychosocial services to survivors and witnesses of mass rape. Research and training are essential to the development of a social work response to the problem of mass rape.Due to the scope of the physical and emotional devastation left in the wake of genocidal rape campaigns, treatment interventions that victims receive are often only marginally available, accessible, or effective. (Arcel et al, 1995; Frljak et al., 1997; Human Rights Watch, 1996; Kozaric-Kovacic, 1995). Timely, appropriate, and decently funded intervention by the United Nations (UN) or other forces (such as individual countries, coalitions, or independent aid organizations) is the best way to protect civilian women from becoming victims during a mass rape campaign. Many organizations provide treatment and intervention for rape trauma tend to survivors’ basic safety and physical needs, which is essential for their physical survival and their mental health (Arcel et al, 1995; Richters, 1997).
Intervention should include the provision of basic amenities, such as food, water, shelter and security, as well as stationary and mobile health and mental health services. Provision of food, clean water, decent housing or shelter, and reasonable protection from further harm have been established as important components of successful recovery; it is widely agreed that little psychological comforting can be accomplished in the absence of “three hots and a cot” (Arcel et al, 1995; Kozaric-Kovacic, 1993; Sharipova, 1997). The provision of relative security in a war zone or recently demilitarized zone can be complicated, and may require partnering with governmental or other organizations that can provide for the basic security of workers and clients, such as the United Nations.
Survivors often have both health and mental health needs, but they are more likely to seek assistance for physical health problems. In order to reach a greater number of survivors in need of social work services, it will be important to partner with health care providers. Frequently, raped women will seek medical care if it is available to them, but they may not disclose their abuse despite obvious trauma to the genitalia or other clear signs of sexual assault (Fischman, 1996; Swiss & Giller, 1993). Women should be sought out for treatment in ways that are not embarrassing because they are not likely to come forward on their own. In a study of over 100 Ugandan victims of wartime rape, “only half told anyone about the rape despite the fact that they all still had problems related to the rape when they finally spoke of it” (Swiss & Giller, 1993, p. 612). Confidentiality should be strictly observed, and all possible efforts to protect and restore the victim’s pride, self-respect, and image in the community should be made.
Because health care is virtually absent in war and is denied to victims of genocidal rape by virtue of the fact that they are intended to suffer and die, mobile and stationary rape crisis centers with teams able to respond to acute and severe trauma should be mobilized in these areas. The services provided should include physical health care and emergency services including transportation, mental health counseling, abortion, pain management, and evidence collection for later use at trials. Reports of sexual violence should be collected in a more systematic manner, keeping in mind the need for privacy and sensitivity in order to obtain testimony from rape victims. (Human Rights Watch, 1996). Women health care professionals should be included on the teams, because rape survivors overwhelmingly report that they would disclose their abuse to a female, but not a male, examiner or counselor (Human Rights Watch, 1996). These teams would need military or police protection that was trustworthy in order to protect the safety of rape crisis workers in the field. And even then, there is no guarantee of safety for workers in general, and females in particular.
In the aftermath of a genocidal rape campaign, physical and mental health care for victims must be a priority. Victims of sexual abuse during the genocide suffer persistent health problems and generally only receive intermittent, partial or temporary assistance for persistent, all embracing and potentially terminal problems (Frljak et al., 1997; Human Rights Watch, 1996; Kozaric-Kovacic, et al., 1995). Unfortunately the stigma surrounding sexual abuse often dissuades women from seeking the medical assistance they need. Interventions must be made accessible to women in a way that is not perceived as shameful to women and does not call attention to the sexual nature of the crime. Clinics must be established in such a way that it is not obvious what a woman is going in for (i.e. it should not be called a “rape crisis center” and only treat people for that type of problem; it should be a women’s medical facility that also provides quality treatment to survivors of sexual violence). It is essential that mental health service providers collaborate with providers of physical health care for survivors.
Mental health counseling should be available to rape survivors on an ongoing basis for as long as they need it. Survivors of the Rwandan genocide in 1994 reported utilizing rape-counseling services, if the counselor was a woman, and if the services were available to them (African Rights, 2004). In a ten-year follow-up study, survivors accessing mental health counseling had better overall outcomes than those who did not get counseling (there was no difference in access to health care services between the women who has received counseling and those who had not) (African Rights, 2004). Following a mass rape campaign, social work services may be provided to the victimized population, and these services can be extremely varied in terms of scope, focus, and theoretical framework. Individual, small group, large group, and family psychotherapy may be employed (Arcel, 1995; Pierotti, 1997; Webb, 2004). Counseling services may rely upon different theoretical frameworks, including empowerment or client-centered, psychoanalytic, cognitive-behavioral, mixed, or other paradigms (Arcel et al, 1995). In the field of mass crisis response, often counseling focuses on practical strategies for coping with the trauma that they have suffered and moving on with their lives (Arcel et al, 1995; Webb, 2004).
It is especially important to advocate for strengths based services, because of the humiliation and demoralization that genocidal rape survivors face. When staggering numbers of women are severely traumatized at once through mass rape campaigns, the strengths approach is particularly appropriate because it highlights existing abilities, beneficial qualities, and other positive factors that may assist in the recovery process. Social welfare is a leader among other professions, fields, and disciplines in the application of a strengths perspective to problem solving. Social workers help their clients solve problems, reach psychosocial goals, and facilitate positive human relationships through a strengths approach. A direct social work response to mass rape could provide valuable assistance to survivors as they rebuild their mental health, social networks, economic stability, and return to their lives.
The social work profession is uniquely suited to respond to the problems of mass rape because of historic, ideological, and pragmatic factors. The field is well versed in the psychology, sociology, and the politics of rape, as well as medical, psychiatric, and forensic responses to sexual violence. The strengths perspective combined with the pragmatism of social work’s approach to understanding and solving problems could be applied in the aftermath of mass rape to aid in the recovery of traumatized individuals, families, and communities.
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