Friends
As we continue with the Acholi violence, and dealing with our educated elites,
as Ugandans we must sit down and contemplate on the net effects of their
actions since they returned from Tanzania. There are classifications that I
never saw Uganda lined up when Amin was the president, yet today we have a
first seat in every classification. The second highest thing taking money from
donors towards Uganda after humanitarian AID, is to study Acholi violence.
Uganda has been listed as a very drunkard country. We are listed as corrupt
country. We have the most women in UK jails. We are now listed by Isis-Women’s
International Cross-Cultural Exchange as a country way high in raping women
during wars, and they specifically list Kitgum. Listen to this, in South Sudan
they rape 2.2%, Uganda {Northern Uganda} 28.8% and Liberia 62%. Ugandans we
never had these numbers till when the degree holders took the mantle of leading
our country. “War Related Sexual Violence in Africa: Medical and psychological
consequences on Women and girls”
We need to discuss Acholi violence candidly
Psychological consequences
Psychological consequences of war related sexual violence
include post-traumatic stress disorder (PTSD), anxiety disorders
including phobias, psychosomatic symptoms, psychogenic pain,
conversion-dissociative disorder, major depressive disorder,
self-injurious behavior including suicidality, alcohol and
substance abuse and altered self-image and view of the world
[9,11,12].
Isis-WICCE Research findings
Over the last 13 years, Isis-WICCE an International women’s
organization based in Uganda has been involved in systematic
documentation of women’s experiences in war, including the
reproductive and psychological consequences of war sexual
violence [14-21]. This work was initially undertaken in Uganda
but has now been extended to Southern Sudan and Liberia. In
undertaking this documentation, Isis-WICCE has worked with
medical professional bodies in the participating countries.
Most of the research findings have been obtained through field
research and from women accessing the services of emergency
short term medical interventions that Isis-WICCE has carried
out in war affected communities.
Prevalence of war related sexual violence
The research findings noted that sexual violence was a common
form of war torture practiced in all the war affected communities.
The prevalence of sexual violence among women varied from
2.2% in Southern Sudan, 28.6% in Kitgum, Northern Uganda
and the highest rate of 62.5% in Liberia [18-20]. In Southern
Sudan, while only 2.2% of the women reported having suffered
rape, 41.9% reported having witnessed the rape of someone
[19]. This however reflects underreporting of one’s personal
experience of rape which could be attributed to intense stigma
attached to rape as observed by one key informant from the
Southern Sudan report:
“We witnessed and saw with our own eyes our own women
being sexually abused. All the warring groups including the
government were responsible, though senior officers used to
prevent these activities.” [20].
Nature of sexual violence
Sexual violence in these studies took on many forms, and
included: single episode rape, gang rape, attempted rape,
forced marriage, abduction with sex, defilement, incest, and
forceful insertion of objects into the vagina, sexual comforting
and witnessing the rape of others [14-21].
There were however local variations to these sexual violence
experiences ranging from serial gang rape and single episode
rape, with dire consequences of trauma on the victims as
illustrated:
“I was 30 years old and married when I was gang raped….. first
by six soldiers who found me hiding and they raped me one after
another starting with their commander. This lasted three hours.
The last one closed my legs and barked at me. I could not even
talk nor walk. My relatives discovered me later soaked in blood,
urine faeces and semen….. Weeks later I was again gang raped
at a military checkpoint by 15 soldiers …” [14].
Many family members testified of the trauma they experienced
as they were used as objects on which to rape the women as
clearly illustrated in the “mattress rape” from South Sudan:
“We witnessed cases (of rape) when men were used as
mattresses. A man would be told to sleep down on the floor
while facing up, and then his wife would be laid on top of him
and systematically raped by the army”. [19].
The long term implication of violations of women’s bodily
integrity increases their vulnerability and exposes them to
social economic hardships:
Violation of women’s bodily integrity
Women survivors testified about the harm done to their
reproductive health systems thereby increasing their suffering
and trauma. A respondent from Liberia shared her experience:
“..After the rape, I started bleeding heavily and my back still
hurts.. My bladder was affected and I could not hold pupu
(faeces). Up to now, I feel like urinating anytime and if I delay
for some seconds, the urine can come out uncontrollably…
Sometimes I can delay to go into my periods. At times I can
delay for seven days or even spend three months without
menstruating. In fact the doctors told me I cannot give birth
again because my womb was spoilt...” [19].
The breakdown of health facilities and services during war has
also subjected many women and girls to reproductive health
complications that for medical practitioners will take long to
heal. An attending gynecologist narrated his experiences of
women war survivors of Teso region, Eastern Uganda:
“A 32 old woman who sustained a genital tear in the late 1980’s
during the insurgency. In her first pregnancy, the labor pains
started at night and she could not go to the health centre because
of fear of the rebels. She delivered at home assisted by a nearby
traditional birth attendant. The baby was big. This caused a
tear in her birth canal communicating with the anal canal (third
degree tear). Initially, she could not control faeces…..” [16].
Psychological consequences of sexual violence
The most severe and long lasting yet invisible consequences of
war sexual violence are the psychological complications. These
range from the immediate aftereffects of sexual violence which
include acute stress reactions and adjustment disorders to the
longer lasting post-traumatic stress disorders. Others include
depression, alcohol abuse disorder, suicidality, conversion dissociative
disorders and various other anxiety disorders. In
most of the Isis-WICCE studies, up to 60% of the respondents
had significant psychological distress scores suggestive mental
disorders [14-21] as indicated by the survivors from Uganda:
“I was tortured, raped, beaten and my son and husband killed.
My home was destroyed, -everything. I have suffered too much.
Now I hear of war coming from Congo. Well, I have my poison
capsules ready. If they approach my village, I will swallow them
and die. I can’t live through more war”. [14].
“…Another problem that I have seen common with many people
and even with me is that when I hear a gunshot, I get diarrhea
straightaway and my heartbeat increases. Sometimes I even
collapse, and this just comes from nowhere. It just happens. And
when the gunshots continue, my chest just goes on pounding.
It is happening to me even right now. I never used to have this
problem in the past.. it is the gun that I think has caused this
problem because every time I hear a gunshot, my stomach
becomes hot, makes noise and I get diarrhea. I even faint, and
my body remains shaking for some time.” [18].
Inability to engage in economic activity
The various Isis-WICCE studies observed a negative impact on
economic productivity due to these medical consequences of
war related sexual violence. In Kitgum, Uganda, (2006), 30% of
the women with gynecological complaints reported that these
problems were interfering ‘a lot’ with their ability to work [18].
In Liberia (2008), 69% of those with significant psychological
distress reported that the psychological symptoms were
affecting their ability to work [20], with serious consequences
on their livelihoods as below:
“The armed conflict in Liberia seriously eroded the population’s
ability to rehabilitate their livelihoods. With farming as the
only form of occupation for most of the population, and given
the inadequacy of supply of agricultural inputs and planting
materials, there has been a rise in unemployment for all and
increase of the production burden for women”.
This reflects a carry forward of the situation from the war time
period as one female survivor testified:
“...in 2001, MODEL (Movement for the Democracy in Liberia)
rebels came while I was in Pleebo town and I left with my
children…. While in Grand Kru county, my husband abandoned
me… I started loving an LPC (Liberia Peace Council) rebel. He
and I had 4 children and when I was pregnant with the fifth
child, my rebel husband got killed. Right now, I am selling fish
while children are selling wood in order to earn a living...” [20].
Therefore, attaining the highest level of health is not only
a fundamental human right for women but it is also a social
and economic imperative. Hence, addressing the reproductive
health consequences of war sexual violence is important to
ensure that women and girls are active and participate in peace
building and post conflict reconstruction processes.
Conclusion:
War sexual violence continues unabated in Africa. This is having
a heavy toll on the health of women and girls, not only causing
reproductive health problems and crippling psychological pain,
but also having a negative impact on their socio-economic
status. Unfortunately, most peace building and rehabilitation
programmes for conflict and post-conflict communities in
Africa tend to pay lip service to addressing women and girls
reproductive and psychological health concerns.
Recommendation:
• African heads of state, having signed the UNSCR 1325 and 1820 should as a
matter of urgency address needs of women in war
and post conflict situations, and more importantly put in place comprehensive
and multidisciplinary health systems to address
the reproductive health and psychological concerns that result from conflict.
• Governments in Africa must commit themselves to stopping all acts of war
related violence on women’s bodily integrity in line
with the principle of Gender Equality enshrined in Article (4L) of the AU All
Constitutive Act.
• The African Union should hold accountable those governments where these acts
are taking place indiscriminately.
• African leaders should apply the principles which they have committed
themselves to regarding fighting impunity on the
continent, as well as ensuring that the rights of women and girls are upheld.
• The Peace and Security Council of the African Union must include under its
mandate the prevention of war sexual violence and
enable proper planning and protection of women and girls in war and conflict
areas on the Continent.
References:
1. American Psychiatric Association, 1995. F43.1 Posttraumatic stress disorder.
In: Diagnostic and Statistical manual of mental disorders, Fourth Edition,
Washington, 435-440.
2. Amnesty International, 2011. Sexual violence and other human rights abuses
must stop, Amnesty International, Cote d’Ivoire, http://allafrica.com./
stories/201102230889.html.
3. Isis-WICCE, 2008. A situational analysis of the women survivors of the
1989-2003 armed conflict in Liberia, Isis-WICCE, Kampala, Uganda.
4. Isis-WICCE, 2002. Documentation of Teso women’s experiences of armed
conflict 1987-2001, Isis-WICCE, Kampala, Uganda.
5. Isis-WICCE, 2001. Medical interventional study of war affected Gulu
district, Isis-WICCE, Kampala, Uganda.
6. Isis-WICCE, 2006. Medical interventional study of war affected Kitgum
district, Isis-WICCE, Kampala, Uganda.
7. sis-WICCE, 2002. Medical interventional study of war affected Teso region,
Isis-WICCE, Kampala, Uganda.
8. Isis-WICCE, 1999. The short term intervention on the psychological and
gynecological consequences of armed conflict in Luweero district, Part 2,
Kampala,
Uganda.
9. Isis-WICCE, 2007. Women’s experiences during armed conflict in Southern
Sudan, 1983-2005: The case of Juba County, Central Equatoria State, Isis-WICCE,
Kampala, Uganda.
10. Johnson K. et al, 2008. Association of combatant status and sexual violence
with health and mental health outcomes in post conflict Liberia, Journal of
American Medical Association (JAMA), Downloaded from jama.ama-assn.org,
18/03/2011, 300; 6: page 676-690.
11. Joachim I, 2005. Sexualised violence in war and its consequences. In:
Violence against women in war: Handbook for professionals working with
traumatized
women. Edited by Medica Mondiale. Cologne, Medica Mondiale, 63-110
12. Kinyanda E, et al, 2010. War related sexual violence and its medical and
psychological consequences as seen in Kitgum, Northern Uganda: A cross-sectional
study. BMC Int Health Human Rights; 10(1): 28 doi: 10.1186/1472-698X-10-28.
13. Liebling-Kalifani H, et al, 2008. Violence against women in Northern
Uganda: The neglected health consequences of war. JIWS, , 9: 174-191
14. Longombe A O, Claude KM, Ruminjo J, 2008: Fistula and traumatic genital
injury from sexual violence in a conflict setting in Eastern Congo: Case
studies. RHM,
16(31): 132-141.
15. Lunde I, Ortmann J, 1998. Sexual torture and the treatment of its
consequences. In: Torture and its consequences – current treatment approaches.
Edited by
Basoglu M. Cambridge, Cambridge University Press, 310-329
16. Physicians for Human Rights:, 2002. War-related sexual violence in Sierra
Leone: A population based assessment. http:// physiciansforhumanrights.org
17. Skylv G, 1998. The physical sequelae of torture. In: Torture and its
consequences – current treatment approaches. Edited by Basoglu M. Cambridge,
Cambridge
University Press, 38-55.
18. TPO Uganda, 2010. Psychological effects of war: A factor to high risk
sexual behavior, TPO, Uganda, Kampala.
19. United Nations, 2008. Resolution 1820 (2008) Adopted by the Security
Council at 5916th meeting, on 19th June 2008. S/RES/1820.
20. Ward J, Marsh M, 2006. Sexual violence against women and girls in war and
its aftermath: Realities, responses and required resources. In: Proceedings of
the
Symposium on sexual violence in conflict and beyond, Brussels, Belgium; 21-23
June 2006
Stay in the forum for Series One hundred and thirty nine on the way ------>
EM
On the 49th Parallel
Thé Mulindwas Communication Group
"With Yoweri Museveni, Ssabassajja and Dr. Kiiza Besigye, Uganda is in anarchy"
Kuungana Mulindwa Mawasiliano Kikundi
"Pamoja na Yoweri Museveni, Ssabassajja na Dk. Kiiza Besigye, Uganda ni katika
machafuko"
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