FHP&R

August 03, 2010

Media Contact: Matt Pueschel, FHP&R/International Health Strategic Communications
Voice: 703-681-3279, x157 E-mail: matthew.pueschel.ctr@tma.osd.mil

In a surprise finding, a new study conducted in the Eastern Democratic Republic of the Congo (DRC) has revealed that perpetrators and victims of high rates of sexual gender-based violence (SGBV) in the region include large numbers of both men and women and were associated with increased post-traumatic stress disorder (PTSD) and depression, as well as physical health outcomes.

The study was co-funded by DoD’s Africa Command, the nongovernmental organization (NGO) International Medical Corps, and McGill University. The results suggest an opportunity for increased and more directed civil-military collaborative medical outreach efforts in the region. “U.S. AFRICOM was pleased to have played a role in making this research possible to help inform institutions and organizations involved in SGBV outreach and assistance programs in the DRC,” U.S. Africa Command officials said.

The study, “Association of Sexual Violence and Human Rights Violations With Physical and Mental Health in Territories of the Eastern DRC,” was published in the Aug. 4 Journal of the American Medical Association (JAMA) at http://jama.ama-assn.org/cgi/content/short/304/5/553. The results showed that self-reported sexual violence (SV) occurred in nearly 40 percent of adult females and 24 percent of adult males in North and South Kivu provinces and Ituri district. Females perpetrated conflict-related SV in about 41 percent of the female victims’ cases and 10 percent of the male cases. “The quantity surprised me,” said the study’s senior author Dr. Lynn Lawry, Senior Humanitarian Assistance/NGO Specialist for the International Health Division (IHD) within the Department of Defense Office of Force Health Protection & Readiness (FHP&R). “The overall rate of sexual violence was twice what I expected. Furthermore perpetrators were both women and men, it was not just men. We also can no longer continue to ignore men as victims.”

The study suggests any new effective healthcare delivery strategies that might be developed in eastern DRC will need to address both women and men who have experienced SV. “Protection from sexual gender-based violence should be considered by the U.N. to include men and boys,” advised Dr. Lawry, who is seconded to IHD through the Center for Disaster and Humanitarian Assistance Medicine. “It challenges the paradigms of men not being victims, and challenges the myth that women are not perpetrators. It’s fascinating, high interest, and contradicts the accepted paradigm.”

The population-based study further indicated that about 67 percent of the survey population in North and South Kivu and Ituri district reported incidents of conflict-related human rights abuses, such as property, physical or sexual violations committed against survey respondents or their follow household members. Meanwhile, 41 percent of the adult population represented in the study met the symptom criteria for major depressive disorder

and 50 percent met the criteria for PTSD. With the addition of sexual violence, those rates nearly double. “That’s a huge psychological burden that has to be addressed. I didn’t expect human rights violations to be so high and also so violent,” Dr. Lawry said.

Africa Command officials said Dr. Lawry’s presentation of the research results to their staff in July provided thought-provoking discussion on the issue.

The researchers further found that 67 percent of adults have inadequate access to healthcare and 95 percent have inadequate access to mental healthcare. Furthermore, based on current population estimates, the extrapolated randomized survey sample indicates that as many as 1.31 million women and 760,000 men in the region may have suffered SV and might need SV-related healthcare services. “Rehabilitation centers with psychosocial support, including programs to address mental health, justice and livelihoods, were listed as the most common need followed by education, income generation and religious counseling/support,” the researchers reported.

The communities surveyed in the study are not currently rebel-held, but still have rebel and FARDC (Congolese armed forces) incursions. The war fought on Congolese land among six countries, which was ignited by an influx of armed Hutu militias that had fled Rwanda and proceeded to attack DRC ethnic Tutsis, was declared over in 2003 after leaving millions dead and the country’s riches looted. But these areas are still considered at-risk to being infiltrated by active combatant groups. Residents are left coping with a seemingly perpetual recent violent history in which civil conflict and instability have reigned for more than a decade and placed the DRC on the list of the world’s worst humanitarian crises.

The study’s mix of several university, NGO and DoD-affiliated researchers collaborated with Congolese interviewers and translators to conduct the cross-sectional study over four weeks in March, 2010. The 24 surveyors set out in three teams, walking through jungle paths, and riding motorcycles and dug-out canoes to reach some of the more remote villages. The study comprised a sample of 67 clusters or villages and 998 households, representing 5.5 million adults in the three areas surveyed. “We tried very hard not to eliminate villages because they were hard to get to,” Dr. Lawry said.

DoD’s International Health Division, of which Dr. Lawry is a member, develops policies that encourage the U.S. Military Health System (MHS) to plan and work closely with civilian U.S. development agencies, foreign governments and security forces, NGOs and international organizations to pursue effective ways of providing medical support and building local healthcare capacity to enhance stability in combat, post-conflict, disaster or at-risk countries like DRC. “We need to make sure we understand the host nation’s culture and its health infrastructure requirements,” advised the division’s director Dr. Warner Anderson. “We need to ensure what we are doing is what they need. We have to work with host country health advisors and our interagency civilian counterparts during humanitarian missions to create a lasting benefit and then sustain that. We are also trying to tap into the knowledge base of the civilian and academic community to help improve how DoD conducts medical support activities in these vulnerable countries.”

For more information, please go to http://www.fhpr.osd.mil/intlhealth.

Research [News]  |  FHP&R   international health   research