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.
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