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What are the consequences of sexual violence for women and men in the Democratic Republic of Congo and

what can institutions do to improve peoples experiences of health and wellbeing? The World Health Organisation defines health and wellbeing as 'A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.'1 Although individual experience isnt homogenous, the people of the Democratic Republic of Congo (DRC) have all had to live in an environment where the atrocities of mass rape, murder, mutilation and abduction are daily realities. All of these traumatic events entail physical, mental and social consequences and the aetiology of the consequences of these experiences is multifaceted. Through examining the manifestations of sexual violence for women and men, this essay will aim to identify what institutions can do to improve these peoples experiences of health and wellbeing. The DRC is notorious for being the rape capital of the world2 as described by the UNs special representative on sexual violence in conflict. Estimates indicate between 25-75% of women will be subject to sexual violence at some point in their life with the average number of assailants in some provinces being estimated at 4.5 per victim.3 Men arent only perpetrators of sexual violence but are victims too, with surveys showing that up to 24%4 of men reporting being victims of sexual violence. These findings should help eradicate the misconception that rape in the DRC is because men have an insatiable libido; rape is a weapon used to achieve economic ambitions, maintain hegemonic social constructions of masculinity5, destroy community resilience and create continued instability. Moreover, sexual violence against women is illustrative of the misogyny that is engrained into the countrys legislation and culture; the incomprehensible prevalence and persistence of sexual violence in the DRC is why this area was chosen for study. Just as there are multifarious historical, political and social determinants that facilitated sexual violence to become so pervasive in the DRC, there are also many physical, mental and social manifestations. Women in the DRC have historically been disproportionately disadvantaged socially and economically 61% of women live underneath the poverty threshold against 51.3% for men, while 44% of women cannot attain economic autonomy.6 The war exacerbated these disadvantages and has forced females into sexual slavery as their position in society is further marginalised. A widespread condition called traumatic gynaecologic fistula is illustrative of the extremely brutal nature of attacks on
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(2013). Health: a state of well-being. Available: http://www.who.int/features/factfiles/health/en/. Last accessed 31.03.2014 2 http://news.bbc.co.uk/1/hi/8650112.stm
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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 6 http://www.peacewomen.org/assets/file/Resources/NGO/hrinst_genderinequalityinthedrc_wilpf_december2010

women, caused by the destructive insertion of guns and sticks into the women's vaginas that tears the walls of the vagina and rectum.7 Women are left incontinent as their reproductive organs are torn apart, the perpetrators of the attacks deriving no obvious pleasure from their barbaric actions and thus reinforcing the notion that sexual violence is used as a strategic weapon to assert dominance. Falconberg concurs and provides an equally horrific example when he writes that After gang raping women and girls, soldiers are piercing their labia and padlocking their vaginas shut.8 Gangs are choosing to attack a part of the female anatomy that should represent intimacy, pleasure and reproduction. Through sexual violence, they are transforming social perceptions of sexual relations and are constructing negative associations with the vagina; sex and the vagina have become synonymous with trauma, social suffering and humiliation. The destruction of the part of the female body meant for reproduction is simultaneously an attack on the individual as well as a metaphoric attack on life, birth and any change to the current societal structure. Through violation of the physical body, those who commit atrocities aim to alter or completely remove the way victims identify with the self, leaving women feeling helpless and submissive: We are slaves of armed groups. They can do whatever they like and we cant do anything about it.9 Thus, gangs are using the female body as a route through which to communicate their own concepts of power, societal structure and identity. Because violence is experienced both collectively and individually, the attack on the physical body is symbolic of how armed groups want to narrate the body politic. By brutally distorting the physical self and removing the ability for individuals to identify with themselves, those committing violence aim to replace personal selfhood and humanity with inscribed social, political and gender ideology.10 ****MORE*** Being physically healthy is often a prerequisite for sound mental health and the two concepts are rarely mutually exclusive; the attack on the female physical body is simultaneously an attack on mental and social wellbeing too. The suffering of women as a result of sexual violence is exacerbated by a society where victims are humiliated and subject to stigmatisation. A study of women in an Eastern region in the DRC showed that Of the 193 women surveyed, (75.7%) experienced rape. 29% of raped women were rejected by their families.11 Victims of rape are labelled contaminated with HIV and are often blamed for their suffering, they are viewed as being promiscuous and therefore
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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 8 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 9 http://www.conflictandhealth.com/content/5/1/25
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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 11 http://www.conflictandhealth.com/content/5/1/25

deserving of rape. Many women are disregarded and discarded by their husbands and family at a time when they are most vulnerable; a time when strong connections with family, friends and the community is essential for coping with distress. Due to fear of persecution and abandonment, many women suffer in silence through an internalisation of their trauma. Rates of non-report of in the DRC are as high as 75% at the time of seeking medical care12 in some provinces. A common consequence of this internalisation by women is the somatisation of their suffering; the manifestation of psychological distress through bodily symptoms such as aching stomachs and chest pain. This somatisation is indicative of the lack of mental healthcare facilities in the DRC, the lack of health education and the societal phenomenon of humiliation. Furthermore, not only are women persistently plagued by sexual violence but also they are subsequently victims of psychological attacks and rejection by the community. Women arent just in a subordinate role in society to men; it must be argued that there is in fact a missing gender in the DRC. The role of women has been so diluted and manipulated by perpetrators of violence that the concept of being a woman in the DRC has lost all meaning other than to serve political, economic and ideological ambitions. There will be no women in the DRC until sexual violence subsides, the phenomenon of humiliation discontinues and there is progress towards social and economic equality between women and men. Men are not only perpetrators of sexual violence in the DRC but are victims too and there is a degree of epistemological myopia in the literature on the consequences of sexual violence for men. An IRIN survey of 1000 villagers in North and South Kivu was one of the first to question victims on the gender of their attackers and it revealed that 41% of female and 10% of male survivors of conflict-related sexual violence said the perpetrator was a woman.13 These findings are illustrative of the socially encompassing nature of the violence. There is an invisibility afflicted on male victims of sexual violence who suffer in silence and due to stagnating economic conditions exacerbating the issue; a social phenomenon of unattainable masculinity has developed. An integral component of the traditional concept of masculinity in the DRC and in most countries is being able to provide for and protect your family. However, in many incidents of sexual violence amongst men there has been a continued threat to the family of males where the consequence of protecting their family is often forced incest, mutilation and death. Even if the men obey the perpetrators there is no guarantee of survival. Thus, through persistent violence directed towards communities and families, worsened by poor economic conditions, a fundamental route for men to define their masculinity has been eroded and has become unattainable. This erosion of masculinity may be indicative of
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http://jama.jamanetwork.com/article.aspx?articleid=186342 http://www.irinnews.org/report/90081/analysis-rethinking-sexual-violence-in-drc

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why the risk of mental health disorders is about twice the populations rate14 for male victims of sexual violence. Removing the ability for men to achieve what they consider being their purpose in society has drastic consequences on the mental health of males in the DRC, they are left feeling powerless and have anxieties over not being able to provide; they believe their wife will not remain faithful and use this as justification to go and commit acts of sexual violence against other women to reassert their masculinity. Just as there is a missing role for women in the DRC there is an unattainable role for me Evidently, sexual violence in the DRC is not gender specific and there is a need http://books.google.co.uk/books?id=3K4It2sjbWEC&pg=PT31&lpg=PT31&dq=hegemo nic+masculinity+in+the+drc&source=bl&ots=E_FKXexK3X&sig=orifuwfrb0Sos6RteCJ_ku2KSc&hl=en&sa=X&ei=3yZeU76UI9Cp7Aak9oDgDA&ved=0CHYQ6AE wBw#v=onepage&q=hegemonic%20masculinity%20in%20the%20drc&f=false http://www.womenundersiegeproject.org/blog/entry/shocking-attitudes-belie-deepmisogyny-in-congo http://www.peacewomen.org/assets/file/Resources/NGO/hrinst_genderinequalityinthedrc _wilpf_december2010english.pdf

- High rates of depression, twice the country level of non-victims (IRIN) Invisibility Also subject to humiliation and abandonment Social conditioning to engage in sexual violence, last route to assert dominance and feel masculine. If you have suffered sexual violence, your risk of mental health disorders is about twice the populations rate, said study author Lynn Lawry, a humanitarian expert at the International Health Division of the US Department of Defense

Carina Perelli (1992) calls these blood mem- ories, when life becomes broken
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http://www.irinnews.org/report/90081/analysis-rethinking-sexual-violence-in-drc

into a before and after of discontinuities and disruptions. Consciousness is suddenly robbed of the social rationality and normality that previously structured its existence.15 Mental issues are expressed as physical illnesses, disguising weakness. Abdominal pain symbolic of a rape victims distress. Rape can play a significant role in differentiating the warring factions by fostering the mutual rejection and externalisation of the other (Bennett 1994, 29)16

Institutions
The main obstacles to ending sexual violence A sound analytic purchase on the dynamics and distribution of such affliction is, perhaps, a prerequisite to preventing or, at least assuaging it Our psycho-social service tries to help the victims rebuild themselves, but it is not very efficient because we need a lot more resources to rehabilitate the victims psychologically, socially and mentally IRIN Investment, Education, Community involvement, Increase budget for mental health expenditure, Peace building, Reconciliation, Solve impunity 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 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) 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. 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.

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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 16 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

Environment of impunity must end and sexual violence laws must be enforced with a zero tolerance policy. 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. 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. 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. 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. '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 Theres 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). 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.

Conclusion
Incorporate masculinities and femininities Find main assumptions and prove them wrong History of local politics Engagement of course materials, week 1, week 4/5 conflict, plus