You’ve probably noticed that getting annoyed about mainstream media reporting on the Democratic Republic of the Congo is one of my favorite hobbies. So imagine how excited I was when, following the release of the Harvard Humanitarian Initiative‘s report “Now, the World is Without Me: An Investigation of Sexual Violence in the Eastern Democratic Republic of the Congo,” I discovered that almost all of the press coverage of the study reported the findings as “DRC: Now with more rape.”
“That’s funny,” I said to myself, “because I read that report, and that’s not what I thought it said.” Then I realized I recognized one of the names on the author list, Jocelyn Kelly. Jocelyn is the Gender-Based Violence Research Coordinator for the Harvard Humanitarian Initiative (HHI) and has worked extensively on sexual violence in the DRC. When I got in touch with her to ask what gives, she very graciously agreed to an interview to discuss the report.
Check it out:
Kate: So, I read “Now, the World is Without Me.” And then I read the press coverage, and was surprised to see that it all appeared to be along the lines of “z0mg, rape in DRC on the rise!” Am I correct that the actual findings were that overall, reported cases of rape had declined between 2004 and 2008?
Jocelyn: Yes. The news coverage didn’t seem to capture the nuances of the issue. Which can be difficult to do, since DRC is a complex place
Kate: But you found that civilian-perpetrated rape had increased?
Jocelyn: Correct, but it’s important to remember that we are talking about reported cases of civilian rape, which is different from civilian rape as a phenomenon. So what we’re seeing is that more women are coming to Panzi Hospital and reporting that the person that raped them was not a man in uniform, but a civilian. But it’s important to remember there can be multiple causes for this. It may be that due to the expansion of sexual violence services in DRC over the last few years, that women are more able to seek services for rape in general.
Kate: I was also interested to see just how high a proportion of the women presenting at the hospital had been in touch with NGOs. But I was curious what that actually meant.
Jocelyn: This starts to make sense when you think about how large eastern DRC is and how difficult it is for most women to travel all the way to Panzi, which includes paying transportation costs on their own. Instead, many women first access an NGO that is closer to their home, the NGO would provide a referral to Panzi for medical services and then sometimes they would also provide transportation to the hospital.
Kate: So does this statistic tell us anything about how well NGOs are serving the population, or just that it’s difficult for women to get to the hospital without assistance of an NGO?
Jocelyn: It’s hard to take this data and make assumptions about how well NGOs are serving the population. I think services have expanded enormously, and this is beneficial to people who need medical care. However, it’s always hard to know about the populations that are not being reached. It’s really hard to take data from a large reference hospital like Panzi and make assumptions about who is and isn’t coming in for treatment. You could argue that women who present to Panzi represent the most traumatized women who have experienced the most violent rape - hence their need for advanced medical intervention. However, you could also say, that women who don’t get to Panzi are the most vulnerable since they may be killed during the attack, may be too far away or too isolated to get to services. So, you have a difficult problem trying to understand the “true” reality of the situation on the ground. In medicine and public health, we always make these caveats about data like this, which comes from “clinic-based samples.”
Kate: What piece of the puzzle that you would have particularly liked to have was missing from this data?
Jocelyn: I think the difficulty with hospital data is that it’s hard to know where women are coming from. So, it gets back to the question of whether there are communities that are not being reached or served by medical care. The second question I have is how women fare when they leave the hospital. It would be wonderful to have a system where we could continue to follow how women are doing once they leave Panzi. I would also love to see a better information network be created that could link women’s medical history at Panzi with her local clinic. This way we could do a better job of providing continuous care and better following up with women affected by violence.
Kate: One of the other patterns that I thought was interesting was the long lag time between sexual assault and presentation at the hospital. What’s going on there?
Jocelyn: I think this is a heart-breaking finding. What I have seen, at least anecdotally at Panzi is that women will wait until they have suffered injuries or infection from rape that gets worse and worse over months or years. Only when the problem interferes with their ability to work and take care of their children do they finally make the choice to seek services. This is especially sad when you think about the fact that if women present to a clinic 72 hours after a rape they can get life saving interventions like HIV and STI prevention.
Kate: Do you have a sense of how much stigma acts as a deterrent to women seeking treatment?
Jocelyn: It is a huge deterrent. Women often say that they don’t disclose the fact that they have been raped because it will have very destructive consequences for them in their communities. If you are a young girl, you often won’t be able to get married after rape. If you are a married women, you risk having your husband leave you.
Kate: I think that may be one of the hardest things about this issue for Western audiences to understand.
Jocelyn: Yes. It’s extremely difficult for us to understand why a rape survivor might be rejected from her own home after rape. It’s like being punished for being victimized. There still seems to be an element of blame that exists towards women who have been attacked by 20 armed men. A lot of times, we hear from men in the community, “Of course it’s not a woman’s fault for being raped – but, really, she shouldn’t have been in the field alone.” So you see a disclaimer, and then this implicit blame comes through. In fact, stigma is such a big problem for women, they often say it is more traumatic for them than the rape itself. Because the effects of stigma have extremely long-lasting consequences and often result in a great amount of social isolation.
Kate: One of the recommendations in the report is that more localized survivor service provision will help women manage the risk of stigma. I believe the idea is that if services are provided locally and women don’t have to absent themselves from their homes/communities to seek treatment, they can more easily keep people from finding out?
Jocelyn: Yes. And this is also an argument for providing GBV and primary healthcare services in the same place. If women are worried about what people think, they can go to a clinic and make the argument it’s for a regular check-up.
Kate: Can we go back to the finding of a rise in civilian-perpetrated rape for a minute? Because this seems to me to be one of the most interesting findings of the report.
Jocelyn: It’s definitely interesting. And I do think this is a valid trend.
Kate: I am curious whether this represents opportunistic crime (arising out of a chaotic situation or whatever) or if it represents a normalization of sexual violence. Because I suspect these would have very different implications for what we expect to see going forward if the conflict abates.
Jocelyn: I think it’s both – because there are never simple answers. One of the things that HHI believes in is taking a “mixed-methods” research approach to these very complex problems that arise in humanitarian emergencies. So what that means is that we look at quantitative data, like the data from the Panzi hospital charts. But we also get qualitative data – from focus groups and interviews- from the community. And what we’re hearing from the community is that civilian rape is on the rise, and that there are a number of reasons for this. One is that community justice structures that used to very effectively punish (and therefore suppress to some extent) have broken down because of displacement and insecurity. Another is that rape is seen as much more common and perhaps somewhat more acceptable because it is not punished. Another phenomenon that is being described to us by communities is that often demobilized soldiers and war-traumatized youth will be extremely violent within communities and might contribute to crimes like rape.
Kate: What does this tell us about the relationship between initiatives to combat the phenomenon of sexual violence and efforts to end the ongoing conflict in the region?
Jocelyn: I think you absolutely have to end the conflict once and for all to be able to work effectively on the other problems that communities face. As things are now, people can work tirelessly to set up a clinic, or a counseling program, but if soldiers come and kill or displace people in that town, all of the effort and programming is useless. First, security has to be restored to the east (yes, much easier said than done), only then can we really concentrate on the problems that communities face as they try to rebuild.
Kate: Is there anything else that was missed in the media coverage that I didn’t touch on here that you think is important to communicate about the findings?
Jocelyn: Well, I think the media coverage was valuable in the sense that it continued to bring these important issues into the public eye. Even though the war in DRC has been going on for more than a decade, it’s easy to forget that this level of violence exists in the world. However, I think it’s a huge challenge for us as researchers to communicate the limitation and nuances of the research. I think some of these definitely got lost or glossed over in the coverage.
Kate: How big of a deal is it that they basically misreported the main finding?
Jocelyn: You mean reporting that rape in general is one the rise?
Kate: Yeah. I just thought that was really interesting; given that “increase in civilian rape” could’ve been the story.
Jocelyn: Me too! I was in DRC at the time and kind of confused at what the press took away from the report. Interestingly enough, Human Rights Watch has reported that rape did rise in 2009 and rates have more or less stayed at that level in 2010. So rape is still a huge problem, and is not decreasing, but that wasn’t what our report was about.
Kate: I imagine it’s an incredibly difficult proposition to get accurate reporting on this because the combination of lack of understanding and the risk of compassion fatigue really incentivizes sensationalist coverage. And “rape still an issue in DRC, interesting changes in trends” just doesn’t have quite the same ring to it.
Jocelyn: Note to self: make extremely nuanced and factual titles in the future. The press will love it: “Clinic-based sample of data cautiously speaks to some trends of sexual violence in women presenting to Panzi 2005-2008.”
Kate: Stick a “permits limited inferences” in there, and you’ll be on CNN in no time.
Jocelyn: I’m saving that for the coup de grace: “Well, Larry, what you have to remember is this data really permits limited inferences.”