Rates of Sexual Violence Are High in Democratic Republic of the Congo

Two in five women and one in four men in the war-torn eastern region of the Democratic Republic of the Congo (DRC) report that they have been victims of sexual violence, according to a cross-sectional, population-based study.¹ These rates are significantly higher than those reported in other conflicts. Moreover, among respondents reporting sexual violence, 74% of women and 65% of men said that their assault was related to the conflict. Although these assaults were most often perpetrated by men, women were the sole perpetrators in 41% of the assaults against women. More than half of victims of sexual violence had been depressed or had posttraumatic stress disorder (PTSD) in the past year.

Although the conflict in the eastern DRC, which began in the mid-1990s, is considered one of the worst humanitarian crises in the world, reliable data about the prevalence of sexual violence in the country are lacking; most studies have been qualitative or were based on nonrandom samples. In the two population-based studies that have been conducted, the proportion of respondents who had experienced sexual violence was 16–20%, but both studies had narrow definitions of sexual violence and neither determined if the violence was related to the conflict. The current study is the first to assess the prevalence of all forms of interpersonal violence, the circumstances of the attacks, the characteristics of the perpetrators and the mental and physical effects of the violence.

In March 2010, 998 men and women aged 18 or older in 19 eastern territories of the DRC participated in one-on-one interviews. Respondents were asked about their demographic characteristics, physical and mental health, combat experience, history of sexual violence (including type of violence and perpetrator), household members' experiences of human rights abuse (including type of abuse and perpetrator) and household mortality. Symptoms of PTSD were assessed using the PTSD Symptom Scale Interview, and those of major depressive disorder using the Patient Health Questionnaire–9. The researchers estimated weighted population percentages and means for each outcome and used the adjusted Wald test of association to calculate p values for bivariate comparisons.

The majority of the 405 male and 593 female participants were married and Chris-tian, and worked as farmers or herders; their mean age was 40. Eighty percent of respondents owned land and 61% were literate. One in five had served as a combatant at some point in his or her lifetime.

Overall, 42% of women and 31% of men reported having experienced some form of interpersonal violence, and 43% of respondents reported that someone in their household had experienced a sexual human rights violation related to the conflict. Intimate partner violence was reported by 31% of women and 17% of men, and sexual violence by 40% of women and 24% of men.

Among participants reporting sexual violence, 74% of women and 65% of men said the violence was conflict-related. The vast majority of male victims said they had been assaulted by other men (91%), whereas assaults against women were more evenly split among male (59%) and female (41%) perpetrators. Rape was the most common form of sexual violence reported by female victims (51%) and the second most common among male victims (21%); other frequently reported types of sexual violence included molestation, sexual slavery and being forced to undress (15–29%). The consequences of sexual violence included bleeding (32% of women, 12% of men), being beaten (19% of women, 32% of men) and STIs (21% of women, 5% of men). Depression was a common consequence among men (14%) but not among women (1%).

Sixty percent of sexual violence victims had met the criteria for major depressive disorder at some point in the past year, and 70% had met the criteria for PTSD. Moreover, 38% had thought about suicide in the past year, and 29% had ever attempted suicide. Current substance abuse—defined as using drugs or alcohol at least twice a week, or using them to excess every time—was reported by 28% of sexual violence victims.

The authors note that the prevalence of sexual violence found in their study is substantially higher than that reported in other conflicts and indicates that widespread human rights violations and sexual violence have occurred in the eastern territories of the DRC. Moreover, their study is the first to document the high prevalence of sexual violence among men and to show that both men and women are perpetrators of physical and sexual violence. In light of these findings, the investigators stress the importance of including men in policies and definitions related to sexual violence. They add that given the pervasiveness of sexual violence in the area, health care programs that focus on sexual violence and mental health are needed in the eastern DRC.—L. Melhado

REFERENCE

1. Johnson K et al., Association of sexual violence and human rights violations with physical and mental health in territories of the Eastern Democratic Republic of Congo, Journal of the American Medical Association, 2010, 304(5):553–562.