Impunity

http://www.scribd.com/doc/39092172/FS-3-Sexual-Violence-FINAL
The report says the scale and gravity of sexual violence were primarily the result of
the victims lack of access to justice and the impunity that has reigned in recent
decades in Zaire/DRC. Moreover, it notes,the phenomenon of sexual violence
continues today as a result of this near-total impunity, even in areaswhere the fighting
has ended. And it has increased in those areas where fighting is still ongoing.

The successive and concurrent wars in the DRC contributed to widespread
sexualviolence both during the fighting, during the withdrawal of combatants, after
the fighting, in areas wheretroops were stationed, in occupied areas, during patrols,
during reprisals against the civilian populationand during raids conducted by isolated and
sometimes unidentified armed groups

The damage caused to the social fabric due to thecollapse of national institutions and
the repeated conflicts contributed to fostering an atmosphere of impunity and chaos.

Calls for transitional justice mechanisms to beestablished that take into account this
issue, the needs of the victims and of their communities, and theneed to rebuild a
future for Congolese society in which women are stakeholders, and in which
thetraditional political and structural inequalities are corrected. Finally, to effectively
combat sexual violence,reforms of the justice and security sectors will be necessary.
To achieve this, however, firm politicalcommitment and coordinated efforts will
be required

http://www.scribd.com/doc/138763170/Sexual-violence-weapon-of-war-impediment-
to-peace
Traumatic fistula compounds the psychological trauma, fear and stigma that
accompany rape with the same risk of unwanted pregnancy, vulnerability to
sexually transmitted infections (STIs), including HIV, and diminished opportunities to
marry, work or participate in the larger community.
Long-term medical complications for the survivors of violent rape may include
uterine prolapse, infertility and miscarriages.
Post-operative care of women should include trauma counselling, rehabilitation and
physical therapy. Healing, especially of psychological wounds, takes time. Some
women especially those who have had foreign objects forcibly inserted into their
vagina and/or rectum are unable to heal even after repeated surgery, and are left
permanently scarred.
Brussels Call to Action agreed at the International Symposium on Sexual Violence
in Conflict and Beyond in June 2006. First interventions: Healthcare, Second:
Compensation (Although not financially feasible, important to assert in principle),
Third: Rehabilitation medically and psychologically.
The Call to Action demands guarantees for non-repetition. This requires reform of
institutions that are meant to guarantee respect for human rights and, in particular,
respect for women as rights-bearing individuals. There must be an end to impunity
and an inculcation of an aversion to the crimes that these women have suffered. The
security sector (both regular and irregular) must understand the sanctions of
perpetrating violence of this nature, as they are often the greatest aggressors.
n commission research into the causes, impact and magnitude of traumatic fistula in
order to support effective advocacy and to assist in planning effective interventions
n support hospitals to enable them to offer repair services attached to their operating
theatres, with equipment that can be used for improved services for women, including
caesarean sections
n design interventions that include access to anti-retroviral treatments and family
planning care to avoid unwanted pregnancies
n include information regarding traumatic fistula within the curricula of all military
units, peacekeepers and police forces
n standardise UN and international agency emergency responses to include clinical
services including proper medical examinations, emergency contraception, fistula
surgery, qualified personnel
who can offer skilled obstetrical and gynaecological services, appropriate equipment,
counselling and psychological care
n provide resources to strengthen health services: currently, when the annual UN
Inter-Agency Consolidated Appeals Process (CAP) for countries in crisis is launched,
health programmes receive less than a quarter
of requested resources
n develop community systems to document atrocities and refer them to appropriate
national and international legal mechanisms, with the existence of traumatic fistula as
evidence
n work with communities and the media to change community perceptions and
attitudes that exacerbate the stigma, discrimination and exclusion suffered by
affected women
Men
Nevertheless, in the last decade, sexualised violence against men and boys including
rape, sexual torture, mutilation of the genitals, sexual humiliation, sexual
enslavement, forced incest and forced rape
In addition to acts of individual sadism, the main overt purposes of sexualised
violence against men and boys appear to be torture, initiation and integration into
military/paramilitary forces, punishment of individuals and a strategy of war designed
to terrify, demoralise and destroy family and community cohesion.
3

More fundamentally, most sexual violence is a mechanism by which men are placed
or kept in a position subordinate to other men. Male- directed sexual violence helps to
expose the broader phenomenon
of conflict-related sexual violence, including against the women and girls who are the
most numerous victims, for what it is: not boys being boys but an exercise in power
and humiliation.
Male victims need to be fully represented in international justice initiatives and their
inclusion in national laws on sexual violence. The prosecution by the International
Criminal Tribunal for the Former Yugoslavia
4
of perpetrators of sexual violence
against male victims and the Democratic Republic of Congos recent extension of the
crime of rape to include male victims are positive examples.
Psychosocial strategies aimed at the specific needs of male survivors must be
carefully designed to avoid unintentional reinforcement of concepts of male
dominance over women or of homophobia.
IDS sexual violence among men) Rosalind Pechesky perversions of war. (Todd
Salzman - article on mass rape Yugoslavia) (Mindful body - Margaret
Zarkov (Yugoslavia): UN Commission of Experts Final Report documented frequent
incidents of male combatants from all three major ethnic groups being beaten across
the genitals, forced to be naked, raped, castrated yet the international media reported
almost nothing of this. Rapes of women were newsworthy; rapes of men were not,
or rather, rapes of men were not seen because they so transgressed the dominant
cultural narratives of masculinity.
Sexual humiliation of a man from another ethnicity is a proof not only that he is a
lesser man but also that his ethnicity is a lesser ethnicity. Emasculation annihilates the
power of the ethnic other by annihilating the power of its mens masculinity. It is the
mirror image of how raping and impregnating the female ethnic other annihilates her
womanhood, her mens manhood, and the reproductive capacity of their group.
The purpose of rape is to plant the seed of the dominant group; hence denying the
possibility of abortion in such cases becomes an act of war. There is no way to
untangle homophobia, masculinism, misogyny and racism in such acts; their toxic
mix lies at the core of nationalist, imperialist, and militarist projects.
The homophobic-misogynist nexus is critical here Domination, like liberation, always
starts from the body, and cultures of war and ethnic and male supremacy are also
those that harbor a deep belief in the profanity of womens bodies. Thus the
feminization and homophobi-sation of the male enemys body becomes an imperative
of military conquest.
Engage Men Book
http://books.google.co.uk/books?id=3K4It2sjbWEC&pg=PT31&lpg=PT31&dq=hege
monic+masculinity+in+the+drc&source=bl&ots=E_FKXexK3X&sig=orifuwfrb0S-
os6RteCJ_ku2KSc&hl=en&sa=X&ei=3yZeU76UI9Cp7Aak9oDgDA&ved=0CHYQ6
AEwBw#v=onepage&q=hegemonic%20masculinity%20in%20the%20drc&f=false





Violence and the Body: Somatic Expressions of Trauma and Vulnerability during War,
Doug Henry, Article first published online: 8 JAN 2008. Medical Anthropology Quarterly
Volume 20, Issue 3, pages 379398, September 2006

I document how discussions of haypatnsi allowed horrific subjective experiences to become
mediated, enabling conflict survivors to understand and express the pain of their trauma and
vulnerability, and begin recourse toward reestablishing order and control over their lives.
Even these discussions of illness, however, involved competition over control of meanings
and prescriptive models with medical practitioners. Haypatnsi thus reveals how lived,
traumatic experiences and their cultural representations within illness are linked.
Yet violence, warfare, fear, and terror are also social phenomena in that the social rationalities
that previously structured peoples lives may now become magnified, questioned, or altered
(Mbembe and Roitman 1995). With both internal and external orientations, the body is also a
social object, a locus for contested control, and a target to be edited and narrated by others
(Olujic 1999; Ong 1987).
Identity, self, and personhood, as well as physical bodies, are strategic targets of war
(1998:105). War attempts to take from people ways in which they recognize themselves as
human. When separated from its previous context of place and history, the body, as the
existential ground of culture, becomes the referent on which new classifications are created
and contested (Coker 2004; Csordas 1993)
Nordstrom rejects rationalizations that attempt to make sense of war, suggesting that they
come dangerously close to a concern with making war reasonable (Irrational combatants in
DRC)
Feldman attributes this to what he calls cultural anesthesia: the academic banishment of
disconcerting, discordant, and anarchic sensory presences and agents that undermine the
normalising and often silent premises of everyday life (1994:405).
There have been, however, collective experiences, shared sufferings, and social struggles.
Carina Perelli (1992) calls these blood mem- ories, when life becomes broken into a before
and after of discontinuities and disruptions. Consciousness is suddenly robbed of the social
rationality and nor- mality that previously structured its existence.
For Feldman, this break is the mo- ment of existential vertigo, where ones previously held
referents are abruptly and violently dissociated, and social conventions and identities
unexpectedly flounder (1995).
Illnesses, for instance, have meanings that can be socially contested, manipulated, and
affirmed, in ways that both reflect and give meaning to the way sick people experience and
understand distress (Csordas 1983)
thers have observed that indigenous practitioners may become skilled in creatively treating
the effects of warin literally taking the violence out of someone to reintegrate them back
into their communities (Nordstrom 1998; Zartman 2000).
Civilians were often targets of the violence, as combatants sought to use bodily violence to
destroy self- constructions of identity and personhood.
In that the body plays such a key role in the creative processes that shape culture and
experience, scholars have turned to it to understand the multiplicities of ways in which people
interact with attacks to their personhood, family, community, and existence, including how
violence is resisted (Feldman 1991; Good 1977; Green 1998; Jenkins 1991, 1996; Ots 1990;
Scheper-Hughes 1990, 1994; Taussig 1988, 1992).
Yet, as Merleau-Ponty points out, consciousness is more than just ones sense of self, it is the
apprehension of the self as existing in the world and oriented to the places, times, and events
around us (1962). As such, the body becomes a site of contestation, as those with competing
claims over meaning try to inscribe their own version of reality onto individuals
Idioms of power and terror attempted to transform individual bodies into po- litical ones,
using individuals in symbolic ways to express structural domination through torture,
interrogation, dismemberment, rape, or scarification (Turshen and Twagiramariya 1998)
Bodies became loci of contested control between rebels, soldiers, and civilians, as each
attempted to replace personal selfhood and humanity with inscribed social, political, and
gender ideology (Green 1998)
And others became walking examples of deliberate attempts to violate the bodys personal
intimacy, challenging the personal control of the self with a narration by the body politic
(Feldman 1991).
Because war and political conflict are often directed toward a group, the violence is
collectively experienced yet also uniquely and individually manifest.
counter- labyrinths of coping, and counter-memories against fear (1995). I propose that
the local understanding and treatment of hypertension has become one such alterna- tive for
war survivors in Sierra Leone.



Militarized Sexual Violence in South Kivu, Democratic Republic of Congo Bartels, Susan
; Kelly, Jocelyn ; Scott, Jennifer ; Leaning, Jennifer ; Mukwege, Denis ; Joyce, Nina ;
Vanrooyen, Michael Journal of Interpersonal Violence, 2013, Vol.28(2), pp.340-358
Retrospective registry-based study of sexual violence survivors presenting to Panzi Hospital
between 2004 and 2008
4,311 records were analyzed. Perpetrators in this data set were identified as follows: (a) 6%
were civilians; (b) 52% were armed combatants; and (c) 42% were simply identified as
assailant(s) ***P3***
Reports indicate in the range from 17.8% - 39.4% for sexual violence towards women and 4%
- 23.6% for men
Sexual violence-related fistulas in the Democratic Republic of Congo Onsrud, Mathias ;
Sjveian, Solbjrg ; Luhiriri, Roger ; Mukwege, Dennis International Journal of Gynecology
and Obstetrics, 2008, Vol.103(3), pp.265-269
An abnormal or surgically made passage between a hollow or tubular organ and the body
surface, or between two hollow or tubular organs
A retrospective analysis of hospital records from 604 consecutive patients who received
treatment for gynecologic fistulas at Panzi Hospital between November 2005 and November
2007
Of the 604 patients, 24 (4%) reported that their fistulas had been caused by sexual violence;
of these, 5 (0.8%) had developed fistulas as a direct result of forced penetration with foreign
objects and/or gang rapes. ***P1***
Since 1996, the eastern part of the Democratic Republic of Congo (DRC) has been through
several periods of war and insecurity, resulting in the destruction of social networks and
health infrastructure. The total death toll from the conflict has been estimated at 3.9 million
people [1], which has recently been updated by the International Rescue Committee (IRC) to
5.4 million [2]. ***Intro***
In the South Kivu province alone, 27 000 sexual assaults were reported in 2006 ***Intro***
Traumatic gynecologic fistula (TGF) [7] and [8]. This type of fistula is a consequence of
sexual violence and is mostly encountered in conflict or post-conflict areas ***P1***
The etiology of fistula may be multifactorial
The young women who had been kidnapped, abducted, and living in sexual slavery blamed
sexual violence for their fistulas. If they had not been abducted and raped they would
probably not have developed a fistula. The women with fistulas indirectly related to sexual
violence had experienced a multitude of traumas: rape, complicated delivery with fetal death,
and finally fistula development. All these events entail physical, psychological, and social
consequences ***P1***
Some communities consider the development of fistulas as a punishment for immoral sexual
behaviour or witchcraft, and women who have been raped can often be stigmatized and
shunned ***P2***
*** Rape of the Congo: Understanding sexual violence in the conflict in the Democratic
Republic of Congo Meger, Sara Journal of Contemporary African Studies, 2010, Vol.28(2),
p.119-135 Taylor & Francis Group
Five interpretations of sexual violence in conflict: 1) as an integral part of warfare; 2) as an
element of male-to-male communication, usually in the form of symbolic humiliation of one's
opponent; 3) as a means of reaffirming one's own masculinity; 4) as a tool with which to
destroy the culture of one's opponent; and 5) as the outcome of misogyny ***P2***
Rape can play a significant role in differentiating the warring factions by fostering the
mutual rejection and externalisation of the other (Bennett 1994, 29). ***P2***
In most cultures, rape exploits core themes of honour, shame, family and identity
(Nordstrom 1994, 16). ***P2***
The absence of sexual violence in a group's repertoire of violence relates to the degree of
internal hierarchy and discipline within the group, and also how strong of an ideological basis
the group has. ***P3***
There is no doubt that rape is a method in this environment to create continued instability
dominance is very prominent. And it is without question the worst environment that I have seen.
Colonel Roddy Winser, UN Peacekeeper Chief of Staff DRC ***P2***
Many of the victims of sexual violence in the DRC have been subjected to horrific mutilation
that goes far beyond mere rape. A condition called fistula is caused by genitals traumatised by
the destructive insertion of guns and sticks into the women's vaginas that tears the walls of the
vagina and rectum and leave many permanently incontinent ***P1***
According to Falconberg (2008), [a]fter gang raping women and girls, soldiers are piercing
their labia and padlocking their vaginas shut. Hot plastic as well as sticks and bayonets are
being inserted into the women. Six-month-old girls have been raped to death. To intensify
the cruelty, soldiers are even shooting women in the vagina. ***P1***
Systematic means of terrorising the civilian population. ***P2***
In a detailed study of sexual violence occurring in south Kivu, Ohambe et al. (2004, 334)
found that, by far, the most prevalent form of rape against women in the province is gang
rape, with an average of 4.5 attackers per victim. ***P1***
Women in the DRC are disproportionately disadvantaged socially and economically. The war
exacerbated these disadvantages and many women and girls have been forced by the war and
poverty into prostitution as a means of survival, making them even more vulnerable to sexual
violence (Ohambe et al. 2004, 26) ***P2***
Three converging factors relate to explain the prevalence of sexual violence in this conflict:
economic ambition, hegemonic social constructions of masculinity, and the general inability
to enforce discipline among armed groups in the war. (de-individualisation) ***P2***
Women in the DRC have a very low social status in both traditional and civil domains
predating the current conflict. Their inferior status is embedded in both the legal code of the
country, as well as in dominant social customs. ***P2***
The restriction of the illegal exportation of Congolese gold, tin, coltan and other minerals;
and, ending impunity for crimes of sexual violence perpetrated in this conflict. ***P3***
Impact of sexual violence on children in the Eastern Democratic Republic of Congo
Eastern Democratic Republic of Congo (DRC) has been particularly devastating for children
and has been typified by high levels of sexual and gender-based violence (SGBV)
seek to characterize the patterns and impact of sexual violence on children in the Eastern
DRC
Growing threat of attacks from civilians and the very limited prosecution of perpetrators in
general. ***P3***
State Hillary Clinton as one of mankind's greatest atrocities' (Dizolele 2009)
Our findings reveal a distinct pattern of sexual violence against children compared to adults.
A similar pattern has been documented by investigators working in North Kivu (Kalisya et
al. 2011) ***P1***
I was looking for wood when I met a man in military uniform. He spoke Mashi and he took
me to his camp where he raped me. I spent four months in the forest and each day he raped
me. Since this time I have had abdominal pain. ***P1***
In these rural areas, young girls are often less educated than they are in more urban centres,
and we hypothesise that this is the reason for higher incidences of gang rape and sexual
slavery among these girls. ***P2***
Environment of impunity must end and sexual violence laws must be enforced with a zero
tolerance policy. ***P3***
In Eastern DRC, those responsible for upholding the law, such as police, magistrates, judges
and lawyers, are few in number, poorly paid and overwhelmingly male. ***P3*** (Introduce
women into legislation through investment in female education)
Measures to address these deficits should include incorporation of trained female personnel
into the judicial system, mass dissemination of the law and systematic training for all judicial
officials. ***P3***
Over 19% of our participants narratives reported pregnancy as a result of rape. Due to the
circumstances surrounding their conception, these offspring are particularly vulnerable.
Children born of sexual violence have higher morbidity due to malnutrition, are less likely to
be educated, and risk further exploitation and ostracization (Amnesty International 2004b).
***P2***
*** If your husband doesn't humiliate you, other people won't: Gendered attitudes
towards sexual violence in eastern Democratic Republic of Congo
Rape has consequences far beyond the physiological and psychological trauma associated
with the attack
Societal phenomenon, in which the community isolation and shame experienced as a result of
the attack become as important as concerns about the attack itself ***P2***
When wounds and corpses fail to speak: Narratives of violence and rape in Congo
(DRC) Chiwengo
Rwandan Genocide manipulated for political advantage, 'genocide credit' in order to justify
military presence in Congo, human rights abuses and mineral exploitation ***P2***
(More)
http://www.conflictandhealth.com/content/5/1/25
Of the women surveyed, 193 (75.7%) experienced rape. Twenty-nine percent of raped women
were rejected by their families and 6% by their communities. Thirteen percent of women had
a child from rape. Widowhood, husband abandonment, gang rape, and having a child from
rape were significant risk factors for social rejection. Mixed methods findings show rape
survivors were seen as "contaminated" with HIV, contributing to their isolation and over 95%
could not access prophylactic care in time. ***P1***
decimated the government and healthcare infrastructure in this region, creating some of the
worst health and development indicators in the world. ***P2/P3***
WHO estimate between 37% [2] and 75% [3] of the population have no access to healthcare.
A 2008 mortality study conducted by the International Rescue Committee estimates the death
toll from this conflict at around 5.4 million - making it the deadliest war since World War
II [4].
Data on the incidence of sexual violence is difficult to collect due to chronic instability, poor
infrastructure, and the highly sensitive nature of rape in eastern DRC. ***P1***
The United Nations estimates that at least 200, 000 cases of sexual violence have been
reported since the conflict started, which is thought to be a significantly low estimate [11].
A 2011 nation-wide survey published in the American Journal of Public Health found that
approximately 1.69 to 1.80 million women reported having been raped in their lifetime
***P1***
A 2010 population-based survey in eastern DRC found that 40% of women and 24% of men
reported experiencing sexual violence [14]. ***P1*** (Cant forget men, completely
emasculates them, under-reported)
Gang rape and rape in public were often described as occurring in tandem with village attacks
by armed men that also involved looting, rape with instruments such as guns, abduction of the
victim, forced incest (an assailant forcing a family member such as a father or brother to have
sex with the victim), and injury or execution of family members.
As a result of rape, 29% of women were rejected by their families and 6.2% by their
communities ***P2***
Of the 193 women who reported rape, those who were widowed were almost five times as
likely to report feelings of general isolation compared to married women
Women abandoned by their husbands were almost three times as likely to report feelings of
general isolation compared to non-abandoned married women.
Gang-raped women were roughly three times more likely to experience rejection from their
family compared to women who were not gang-raped. ***P2***
The issue of stigmatization and rejection of survivors of violence arose spontaneously and
remained a dominant theme throughout the discussions. Stigmatization in the community was
often expressed as gossip or "finger pointing" (kushota kidole in Kiswahili) ***P2***
'Intensified survivors' feelings of shame and humiliation'
Women in eastern DRC also suffer from traumatic fistulas resulting from violent rape and
obstetric fistulas resulting from lack of prenatal care. Women described fistulas as another
risk factor for rejection:
"Your husband will not accept to stay with such wife whereas there [are] many other women
who are in a good health.... He will tell you that he can not live with a wife who is wetting his
bed every day.
Women noted that in cases when a man truly loves his wife, however, he may choose to assist
rather than repudiate her. < Gender power divide
Even if they are not rejected, however, participants described cycles of blame and anger that
can develop between a husband and wife after rape. Women may face increased risk of abuse
or neglect within the home after rape ***P1***
Thirteen percent of women had a child from rape
Almost half of women polled (44.6%) waited a year or more before seeking SGBV services.
Discussing the services that would be most helpful, women were extremely positive about
educational programs to help communities understand how to accept survivors of
rape. ***P3***
When asked whether they would like to see their attacker arrested for the crime of rape, 58%
of women said they would due to scepticism about the capacity of the police force. ***P3***
The Congolese government was ineffective and the judiciary system was flawed and corrupt.
As one woman said, "We are slaves of [armed groups]. They can do whatever they like and
we can't do anything about it. ***P3***
"revenge attacks, " including rape or murder, once a perpetrator is released from prison.
A 2003 report by Rseau des Femmes pour un Dvelopement Associatif (RFDA) found that
79% of women reported gang rape and 26% reported rejection by their family [20]. Data
gathered by Mdecins Sans Frontires in the Baraka province, from 2000-2004, found that
75% of women reported gang rape [21] ***P1***
'Sexual violence in eastern DRC is a complex and highly destructive feature of the conflict
that creates profound physical, emotional, and social distress. Services to address the
manifold social and medical consequences of rape are inadequate, and stigma and fear of
reprisal attacks may keep women from seeking out the health and legal services that are
available ***P3***
http://onlinelibrary.wiley.com/doi/10.1002/jts.21770/abstract;jsessionid=646FD404EF417726
D396F287E78815D0.f02t01
(Only abstract loaded)
http://jama.jamanetwork.com/article.aspx?articleid=186342
Rates of reported sexual violence were 39.7% (95% confidence interval [CI], 32.2%-47.2%;
n = 224/586) among women and 23.6% (95% CI, 17.3%-29.9%; n = 107/399) among men
Forty-one percent (95% CI, 35.3%-45.8%; n = 374/991) of the represented adult population
met symptom criteria for MDD and 50.1% (95% CI, 43.8%-56.3%; n = 470/989) for PTSD.
Of the studies that evaluate sexual violence in the DRC, the majority do not include all forms
of sexual violence,2
,
3 are largely qualitative,4
-
6 or evaluate patients presenting to medical
care,7which comprise a biased, nonrandomized sample. In many settings, sexual violence
survivors resist speaking out for fear of social stigmatization.8
,
9 Consequently, rates of
nonreport of the event at the time of seeking medical care are as high as 75% and may be
higher in conflict settings.8 ***P1***
Twenty percent of the adult population in the survey area were reported to have served as
combatants at some point during their lifetime (eTable 3). Most reported being conscripted
(abduction/kidnapping) into the armed groups. Both women and men carried out the same
roles within the armed groups with the exception of sexual slavery
Sixty-seven percent (66.7% [95% CI, 59.0%-74.5%]; n = 615/998) of households in the
survey area were reported to experience conflict-related human rights abuses against family
members, including property, physical, and sexual violations
More than twice as many men (46.3% [95% CI, 37.5%-55.0%]; n = 177/398) than women
(21.8% [95% CI, 16.7%-26.8%]; n = 110/579) of the represented population were reported to
be current substance abusers (Probably due to accessibility not desirability)
25.9% (95% CI, 19.5%-32.4%; n = 264/972) have had suicidal ideation during the past year;
and 16.0% (95% CI, 10.8%-21.2%; n = 162/965) have been reported to have attempted
suicide at some point during their lives (Table 4). Extrapolated to the sampling frame
population, 3.25 million (95% CI, 2.84 million-3.66 million) adults meet criteria for
symptoms of PTSD, 2.63 million (95% CI, 2.29 million-2.97 million) adults meet criteria for
symptoms of MDD, 1.68 million (95% CI, 1.27 million-2.10 million) adults have suicidal
ideation, and approximately 1.04 million (95% CI, 0.70 million-1.38 million) adults have
attempted suicide.
There is a need for inclusion of men in sexual violence definitions and policies in addition to
targeted programs to address their needs.
Challenges the myth that women do not have the capacity to commit atrocities despite recent
prosecutions for such crimes.40 Policy makers and donors need to adjust societal paradigms
of sexual violence and direct attention to female perpetrators and male survivors in regard to
rehabilitation and justice. (Gender related) ***P2***
http://web.b.ebscohost.com/ehost/detail?sid=d6354787-c696-45d4-958d-
8cd0b4dcdfe4%40sessionmgr114&vid=1&hid=120&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%
3d%3d#db=buh&AN=67489459
Despite recent attempts at surveying men, the DHS needs to be revised to reflect current
evidence-based work that documents SV and includes women older than 49 years as well as
men of any age. Everyone, whether male or female, is at risk for SV and should have equal
access to documentation of ills.

UGANDA
http://www.sciencedirect.com/science/article/pii/S0277953610002790
Their lives were characterised by high rates of exposure to extreme events, such as deaths,
child abductions, disease epidemics, gender-based violence and poverty.
As a consequence, their level of emotional distress was high. However, they did not readily
speak about their distress
A distinction is made between the processes of victim blaming, self blaming, mimetic
resilience and mirroring resilience. In addition, the consequences of the silencing children are
presented. Children expressed their emotional suffering primarily in physical aches and pains
and used pharmaceuticals and herbal medicines to minimize their distress.
The result was a medicalization of psychological distress. In conclusion, we reflect on the
necessity of a multi-pronged approach to address childrens distress.
In 2005, the Gulu district of northern Uganda had been in a state of complex emergency and
armed conflict for over two decades. The major fighting parties were the Lords Resistance
Army (LRA) and the government army.
In their dire circumstances and having to fend for themselves, they mainly talked about
physical complaints. Many of them, however, depended on tranquillizers to overcome their
sleeping problems (Akello, 2009:109).
Silencing as a dominant strategy to cope with suffering
It has resulted not only in direct loss of life, but also in poverty, a failing healthcare system
and the destruction of the social fabric, leading to a lack of support, neglect and sometimes
outright abuse of children.
Persistent headaches and bodily pain
They met stigmatisation on the part of other children both in their community and at school
once it was known that they took care of people with HIV/AIDS.
Sexual violence, in particular rape, also led to deep emotional distress among children. When
girls alluded to being attacked and suffering from a stomach ache they were speaking of
sexual violence.
Children extensively discussed the dangers that young girls experienced when they went to
dance at night. They were lured by big men, especially soldiers, to have sex with them, and
when they refused, these men simply took them by force.
They were convinced that reporting rape to the authorities would not lead to action against
perpetrators.
Otika should be beaten for his constant crying.
Evidence suggests that attempts to express and disclose individual emotional suffering were
met with indignation, condemnation, irritation, disregard of the victims emotional distress,
and the citing of others comparatively worse experiences
Linked their reluctance to communicate about their suffering to their shame connected with
this disease.
Prevent drawing negative attention to oneself and ones family.
Girls who were sexually violated were commonly held responsible for not protecting
themselves
Tacit communal unspoken consensus was neither talked about nor acknowledged (McKinney,
2007)
In 2005 UNICEF reported that over 50% of displaced women and girls in the Pabbo camp
had been victims of rape and other forms of gender-based violence
One key officer in the security committee discussed during interviews how it was womens
own responsibility to take care of themselves and avoid situations which might expose them
to rape
However, asking Okello to individualize and internalize problems that are caused by damage
to the social fabric far beyond his power amounts to a subtle complicity in the silencing of his
emotional distress, for the perpetuation of his complaints could now be blamed upon his
inability to fully forgive those who hurt him.
The neglect and condemnation of feelings of anger, frustration, and guilt merely caused a
translation of these emotions into the local idiom of revengeful spirits and into somatic
symptoms.
This judgment was followed by an admonishment: one should compare ones suffering with
that of others who suffer in silence. Suffering in silence is considered a sign of strength, a
value even more important for boys than girls.
Comparative or even competitive way of dealing with ones own suffering, which children
describe as a strategy to enhance strength in a person.
We propose the term mirroring resilience for the choice to hide ones distress out of
compassion for the suffering of others. Children argued that showing ones emotional pain
might cause resonating feelings in others. It is egoistic, inconsiderate and bad behavior to
trigger an eruption of collective suffering.
Another way in which distress found expression was through somatic symptoms
Somatisation of their emotional distress served as a channel for seeking self-help, but also led
to over-medicalisation processes that in the long run were detrimental to their health and that
of others, and did not lead to structural solutions for their suffering
http://link.springer.com/article/10.1007/s00127-008-0475-1
This paper presents an approach for evaluating the reliability and validity of mental health
measures in non-Western field settings. We describe this approach using the example of our
development of the Acholi psychosocial assessment instrument (APAI), which is designed to
assess depression-like (two tam, par and kumu), anxiety-like (ma lwor) and conduct problems
(kwo maraco) among war-affected adolescents in northern Uganda.
For example, sitting kumu (sitting while holding ones cheek in their hand) and not greeting
people were described as hallmark symptoms of the local mood disorder kumu.
(Manifestation)
Adolescent reported being abducted, N (%) 74 (42)
Overall, our findings suggest that there are not absolute boundaries between the three
depression-like syndromes (par, two tam and kumu) and the anxiety syndrome (ma lwor).
This agrees with the literature on depression and anxiety that has demonstrated high
comorbidity between anxiety and depression

http://www.ijmhs.com/content/4/1/1
There is an urgent need for more research on the current burden of mental disorders and the
functioning of mental health programs and services in Uganda.
Mental illness and poverty have a dialectical relation, reinforcing and exacerbating each other
Furthermore, there were no legislative provisions to provide support for users in the following
areas: a legal obligation for employers to hire a certain percentage of employees that are
mentally disabled, provisions concerning protection from discrimination at work (dismissal,
lower wages etc) solely on account of mental disorder; and financial provision concerning
protection from discrimination in allocation of housing and subsidised housing schemes for
people with severe mental disorder
About 1% of expenditure by the government health department was directed towards mental
health in primary care.
The health sector's financing was at the time supplemented by funding from the African
Development Bank (ADB), with nearly 45% of the support going to mental health.
Firstly, there is a need for stronger national leadership to finalise and enact the current draft
mental health policy. The policy should also better address the mental health care needs of
children and adolescents. Secondly, there is a need to review the outdated mental health
legislation to bring it up to date with current International Standards.
http://www.sciencedirect.com/science/article/pii/S027795361200295X
In an epidemiological study that was carried out in 2007 and 2008 with N = 1113 youths and
young adults aged between 12 and 25 years in war-affected regions of Northern Uganda we
examined the prevalence, predictors and outcomes of cen, a local variant of spirit possession.
We found that cen was more common among former child soldiers then among subjects
without a history of abduction. Cen was related to extreme levels of traumatic events and
uniquely predicted functional outcome even when the effects of PTSD and depression were
controlled for. Our findings show that a long-lasting war that is accompanied by the
proliferation of spiritual and magical beliefs and propaganda can lead to high levels of
harmful spirit possession.
Spirit possession refers to altered states of consciousness that involve experiences of being
under the control of a powerful entity, such as a god, a demon, a devil or a ghost
Since spirit possession resembles dissociative states that can be found in industrialized
countries (Cardea, 1992), forms of spirit possession that are considered to be pathological
have been interpreted as cultural variants of dissociative disorders.
The most dominant current perspective of dissociation is that these phenomena present a
protective but pathological adaptation to the experience of traumatic events (van der Kolk
et al., 1996)
In this study we investigated spirit possession in the context of an epidemiological survey of
trauma-related disorders in the war-affected regions of Northern Uganda
This war has been infamous for the widespread abduction of children and forced recruitment
of child soldiers by the Lord's Resistance Army (LRA) rebels and extreme levels of brutality
against the civil population. Spirit phenomena have played an outstanding role in this war
since the beginning of the first resistance movement Holy Spirit Mobile Forces initiated in
1985 by Alice Auma
Widespread local beliefs, has been a fertile ground for the development of harmful forms of
spirit possession in the local population, in particular former child soldiers. Next to studies
showing high levels of trauma and PTSD among former child soldiers and civilians, a survey
has found a local variant of spirit possession called cen in about 5% of the war-affected
youths
The Violence, War and Abduction Exposure Scale (VWAES) is a 34 item checklist of
potentially traumatic events that was developed especially for use in the Northern Ugandan
context based on in-depth interviews with 30 former child soldiers (Ertl et al., 2010).
In sum, the findings of our study are consistent with the assumption that spirit possession
phenomena can be a trauma-related psychopathological entity independent from PTSD and
depression. Intense proliferation of spiritual and magical beliefs, have contributed to the
widespread interpretation of psychological damages as transcendent phenomena.
http://www.ijmhs.com/content/5/1/5
The findings revealed that in some Ugandan communities, help is mostly sought from
traditional healers initially, whereas western form of care is usually considered as a last resort.
The factors found to influence help-seeking behaviour within the community include: beliefs
about the causes of mental illness, the nature of service delivery, accessibility and cost,
stigma.
Many participants reported that very often help for persons with mental health problems is
sought from the traditional healers as a first source, before consulting more conventional
Western psychiatric services. One informant estimated up to 65% of people with mental
health problems visit traditional healer.
Factors that influence help seeking behaviour: Help-seeking was noted to depend on a
number of factors such as: beliefs about the causal factors, nature of service delivery, social
economic status, severity of the condition, stigma, testimonies from those who have benefited
from the services and awareness of the availability of services.
With this supernatural theory of disease aetiology, many respondents indicated that people
lacked faith in the ability of conventional psychiatric treatment to treat and cure mental
illness.
The results suggest a need to strengthen the whole health system by providing adequate
human and financial resources to conventional mental health services, and distributing such
services so that they are more accessible to all populations, particularly in rural areas.
Increasing the uptake of mental health services also requires addressing the widespread
stigma surrounding mental illness and those affected.
Indeed, beginning with the Alma Ata Declaration in 1978, and again in 2002, the World
Health Organisation has appealed to governments to start promoting the inclusion and
integration of traditional practitioners in national and donor-specific health programmes.

http://onlinelibrary.wiley.com/doi/10.1002/jts.21764/abstract

http://link.springer.com/article/10.1007/s12529-011-9159-4
http://onlinelibrary.wiley.com/doi/10.1111/j.1532-7795.2012.00802.x/abstract
http://sfxhostedeu.exlibrisgroup.com/44SUS/cgi/core/sfxresolver.cgi
Local perceptions of the mental health effects of the Uganda acquired immunodeficiency
syndrome epidemic

http://www.womenundersiegeproject.org/blog/entry/shocking-attitudes-
belie-deep-misogyny-in-congo