Sarah Khenati is in charge of the "sexual violence" dossier in the Democratic Republic of Congo for the International Committee of the Red Cross (ICRC). Khenati, a trained psychologist, was in Geneva after a 22-month mission in the east of the country, in Goma (North Kivu). In an interview with Heidi.news, the humanitarian discussed her work and the situation on the ground in a country where sexual violence has become endemic.
Heidi.news: You have just returned from a mission of almost two years in the DRC. What is the current situation in terms of sexual violence?
Sarah Khenati: In the DRC, it is a very long-standing problem. We talked about it a lot in the 2000s, after the wars of 1996 and 1998 when it was clearly happening on the battlefield. There was a use of rape as a "tactic of war". And it has never really stopped since then. Today, the real enemy is the trivialisation of the act. Several generations of children have witnessed sexual violence committed against their mothers, their sisters, their grandmothers, and their children after that. It is a form of violence that has become normalised, yet it leads to a systematic rejection of the victims.
Does this mean that the context of this violence has also changed?
Yes, it does. Rape is still used by weapon bearers in the context of armed conflict, but it can also be found in all layers of society, in all forms of crime. The problem with long civil wars is the proliferation of weapons and impunity due to the dysfunction of the justice system. Sexual violence then becomes an opportunistic act by arms bearers who see women passing by without necessarily being ethnically or politically targeted. It also occurs during incursions into villages, to loot and also, as always, to terrorise communities. A study published in 2011 mentions 48 rapes of women per hour in the DRC, but generally, we only see the victims that are seeking help and accessing services. This is just the tip of the iceberg.
Clinical psychologist and art therapist, Sarah Khenati worked for eight years in a psychiatric hospital in Erstein, near Strasbourg, working with victims and perpetrators of sexual violence. She discovered humanitarian work with Médecins Sans Frontières, for whom she carried out missions in the Central African Republic and Palestine before joining the ICRC for missions in South Sudan and Myanmar on the same topic. Since 2019, she has been appointed head of the ICRC's "sexual violence" section for the DRC. At the time of our interview, on 25 May 2021 in Geneva, she returned from a 22-month mission in Goma, the capital of North Kivu, an endemic conflict zone.
When you are a woman in the east of the DRC, are you afraid of being raped as soon as you move?
It's complicated to be a woman everywhere in Congo, not to say dangerous. In Kinshasa too, there are staggering levels of sexual violence linked to persistent criminality. In conflict zones, particularly in the east, men who move outside their community or village risk being killed. So it is the women who go outside to fetch water or food from the fields. Some told me that they knew they would be raped but had no choice because they had to eat and they would rather go themselves than send their daughters. And even after the assault, accessing care without re-exposing oneself is difficult. It's a vicious circle.
What are the consequences for physical health?
It's a real public health problem. The victims, both men and women, risk contracting sexually transmitted diseases, particularly HIV, which is unfortunately still too widespread in the DRC. I have seen young girls who have had fistulas or haemorrhages and can no longer carry water, work in the fields, look after their children or the house. There may also be unsafe abortion attempts in the case of unwanted pregnancies, which can lead to haemorrhaging and sometimes death. There are also the psychological consequences, the feeling of shame experienced by the victims...
How does the rejection of victims manifest itself?
In Africa, the collective and solidarity are the cement of communities, far from a form of individualism that we find in Europe. It is often said that it takes a whole village to raise a child. The persistent conflict destroys this social link; the communities are in survival mode and no longer manage to be supportive, which is a terrible thing for a society. Especially for victims of sexual violence, who are often rejected and stigmatised instead of being supported and protected.
There is the idea that a woman who has been raped has been soiled, that she has lost all dignity, and the husband is often ashamed and rejects her. In Congo, it is still very important for a woman to be able to have children. And sometimes, the rapes are so violent that they become infertile. There is also the fear of HIV infection. In general, if you are a woman in Congo, you don't survive outside a patriarchal family. An unmarried girl will not necessarily be rejected but will often be sent away, placed with an aunt in another community because she will no longer find a husband. They may also be rejected by their friends or family.
What is the ICRC's approach to prevention?
The ICRC uses international humanitarian law as a basis and, in addition to a bilateral and confidential dialogue with the weapon bearers, carries out prevention activities with them. We work on changing behaviour, especially towards civilian populations. This is a long-term project, which is accompanied by assistance to civilian populations. We also work to prevent the stigmatisation of victims within civil society. We try to identify influential actors within communities: state or local authorities, such as a traditional or religious leader, to establish a dialogue and strengthen the self-protection of communities.
Can you tell me more about your work on the rehabilitation of victims?
Yes, this is another part of our work. We provide support for physical and mental health care, and we also provide social and economic support. If we are faced with someone who has imminent needs, to seek care, find food or sleep, in an emergency, we can provide cash assistance. I like this approach because it allows the humanitarian to not think for the person and to let them organise themselves. It also allows the person to avoid exposing themselves to other risks, for example, paying for a motorbike taxi to go to a health centre instead of walking, sometimes risking their life.
In the longer term, a larger sum can be given along with training so that the person can have an income-generating activity. This allows you to start a small business and also to keep a small sum if necessary. Some women tell me, "I want a piece of land, but I keep a little money for my children to go to school". These two forms of support are based on the survivor-centred approach that we have been trying to develop at the ICRC for several years now. Each victim is unique, with unique needs that must be taken into account for a holistic response.
This seems obvious, but often, in a humanitarian context, it is not self-evident because it is difficult to implement. Colleagues often ask me what the process is for dealing with a victim of sexual violence. There are unavoidable measures such as rapid access to care and the PEP [post-exposure prophylaxis] kit within 72 hours to avoid HIV contamination and unwanted pregnancy. But my main advice is to take the time to discuss with the victim, to ask her what she wants, to let her prioritise her needs so that she can return to a normal life as soon as possible.
Itinerary of a young Congolese woman
"I think of a young displaced girl, 16 years old. We met her as part of a family reunification programme because she wanted to find her mother. She already had a little girl, and we realised that she was a child of rape. At the age of 14, she had to flee a conflict zone, found herself all alone and met armed bandits. And this rape made her incontinent. Can you imagine at 16, what hope for life do you have? She was reunited with her mother in a town in the centre of the country, where she had access to basic care and psychosocial support. But she needed reconstructive surgery, which was not available in that town.
We called Dr Mukwege's Panzi foundation in South Kivu, but due to Covid, it was impossible to move her. After a few months, we finally managed to transport her by plane and she was taken care of. She was then able to return home and join our "Cash for Livelihoods" project. She was able to start an income-generating activity. That's the whole point of a person-centred approach. If we hadn't added the socioeconomic component, at 16 and with a baby, it would have been very difficult for her to find a place in society. Without the surgery, the social stigma would have remained. In order to survive, she would have been exposed again to risks of violence, including sexual violence."
It's a huge job. Don't you sometimes feel that it's a drop in the ocean?
Yes, of course. Our mandate is focused on sexual violence related to conflict, other situations of violence and detention, but there is a lot of work to be done on gender-based violence in the broadest sense, domestic violence; other humanitarian actors are working on this. And I would rather have a drop in the bucket than a large programme that doesn't work as well. I would rather help ten people properly than a hundred halfway. In 2020, the ICRC helped 745 people with cash assistance. It's a drop in the bucket, but a big drop!
Do men also suffer sexual violence?
Yes, and it's taboo and shame to the power of ten thousand. It can happen during kidnappings, and it's more a story of torture to put pressure on the victim while waiting for a ransom, but in general, it's mostly a desire to humiliate him. Behind the idea of raping men is the idea of making a woman out of them. We get feedback from men who say, "I've been ridiculed, I've been humiliated, I've been feminised". In Congolese culture, a man who feels he is losing his status as a man loses his dignity and his place in society. There are also quite spectacular rape scenes where the man is forced to watch his wife being raped - this is a form of sexual violence. There is also forced nudity and cases where men are forced to rape other people.
And the humanitarian response is similar to that for women?
One problem with the humanitarian world, in general, is that we have made many very female entry points: maternity wards, midwives, women's associations... We did what we could with the means available, but it's complicated for a man in a patriarchal society to go and ask for care in services that are generally aimed at women. In the DRC, for example, we are rethinking our entry points so that they are in more neutral medical environments, such as health centres or hospitals, outside of gynaecology departments or maternity wards.
But let's face it: it's still a challenge to see men in consultation. Often those we see come in because they are at a stage of violence where the person can no longer walk, bleed to death or cannot sit down. It is so taboo that we have no idea of the real prevalence. For women, the figures are the tip of the iceberg. For men, it is a grain of sand on the beach!
What impact has Covid-19 had on the situation?
It seems that there has been a bit more domestic violence in urban areas, but that is a bit outside our scope. In rural communities, the effect has been limited: when you have to go out to feed yourself, confinement is not an option. Victims were sometimes more reluctant to go to health centres for fear of catching Covid-19. At the ICRC, we have made a point of maintaining our activities despite the pandemic, especially the health and mental health response.
It seemed like the world was coming to a halt in other countries, but the pandemic did not put a stop to armed conflicts. It was even a bit crazy to see the media interest focused on Covid-19 while the humanitarian needs remained massive in the countries where we intervene. Many local organisations were afraid that donors would lose interest and that programmes on sexual violence would be stopped. This does not seem to be the case at the moment, and we continue to insist on the importance of assisting victims of sexual violence so that they have access to quality services but also so that they are not forgotten.
The issue of sexual violence in the DRC has been identified in the humanitarian world for more than twenty years now, and the situation still seems to be just as complicated. Do you think that in twenty years' time we could be having the same conversation?
... I hope not. I can't say anything else; otherwise, I'll quit my job! Let's say I get up in the morning so that in twenty years' time we won't be in this situation.