CAR: Silence aggravates the wounds of sexual violence

23 Jul 2019

Olga describes what happened in a trembling voice: "Yesterday afternoon I left home to go and look for a bit of yucca in a field near the airport. On my way there, two men armed with machetes intercepted me and told me to sit down. One covered my eyes and the other began to undress me." That is how her story begins, which could be that of almost any of the thousands of people who suffer sexual assault in the capital of the Central African Republic (CAR).


Last year MSF assisted almost 4,000 survivors across the Central African Republic. © Mack Alix Mushitsi / MSF

Last year, Médecins Sans Frontières (MSF) assisted almost 4,000 survivors of sexual violence across the country. In the MSF project at the Bangui Community Hospital alone, more than 800 people have been treated in the first half of this year. In CAR, as in many other countries, sexual violence is a taboo subject. In many cases of sexual assault, the victims are forbidden from talking about it due to the shame it will bring on their family. Some of the local languages don’t even have a specific word for rape. "I thought about committing suicide several times. I felt ashamed when I walked down the street and I thought everyone was looking at me. I can’t sleep at night," says Olga, 41, when explaining her situation to the MSF psychologist who treats survivors of sexual assault. The project is called Tongolo, meaning "star" in the Sango language.

"Sexual violence increases during times of conflict. Societies break down, there is  often  a high level of impunity for perpetrators, and this can make people more vulnerable to sexual violence. We want those affected in the areas we work to know we will assist and support them."

Margaret Bell
Women's Health Advisor at MSF’s Sydney-based Medical Unit

A cloak of silence

The long conflict in the country and the presence of armed men on almost any corner increase the danger for sexual violence. "But here, many sexual assaults are committed between neighbours or within the family,” says Beatriz García, coordinator of the Tongolo project. “And in most cases the problem is resolved amicably in the community or between families to avoid bringing shame upon the family, forgetting that this is a medical emergency that must be taken care of."

In order to give the community access to treatment, MSF has extended the Bangui Community Hospital project to the outskirts of Bangui, by opening a new support service in the popular district of Bédé-Combattant. "We are sure that this will allow survivors to arrive in a period of less than 72 hours, which is key for mitigating the possible consequences of the assault,” explains the MSF coordinator. Olga showed up at the new MSF service 24 hours after the assault and was prescribed prophylaxis to protect her from sexually transmitted infections, such as HIV.


In the MSF project at the Bangui Community Hospital alone, more than 800 people have been treated for sexual assault in the first half of 2019. © Mack Alix Mushitsi / MSF

A feeling of relief

Martine, 53, is a widow and has three children. She seems relaxed as she leaves a psychological consultation at the centre in Bédé-Combattant. “I feel relieved. I’d been carrying a weight on my shoulders for six years. I hadn’t told anyone what had happened to me, but then some people told me that I had no reason to feel afraid or ashamed. And here I am,” she says. "During the fighting in 2013, I took refuge in the forest. There, two armed men took me by force and raped me. I then had intense pains in my groin, I felt dirty and I was terrified of meeting armed men,” she explains, without losing her composure. Martine will now have a free weekly consultation in the MSF mental health service.

In Bangui, there is a gap in assistance services for victims of sexual violence. Beyond the medical services offered by MSF, there is no legal or socio-economic support available to victims to help them overcome the consequences and challenges of the aggressions they suffered. It is essential to make this problem visible in order to attract the attention of donors, authorities and humanitarian agencies. Unmet needs for sexual violence remain huge.

"Sexual violence is a medical emergency. There is an opportunity to prevent mortality, morbidity, HIV and sexually-transmitted diseases, and apart from the obvious consequences of violence, there are many other ongoing effects."

Margaret Bell
Women's Health Advisor at MSF’s Sydney-based Medical Unit

Thanks in part to various awareness campaigns, the population is beginning to realise the scale of the problem, with many survivors, like Martine, turning up to the MSF services a long time, even years, after the incident. The project is open to the entire population but places special emphasis on treating children and men, because these cases are even less visible and tend to be more complex. “In CAR, there are many men who have suffered sexual assault but who are too scared to speak up. Hardly any of them come to our treatment centres. They are reluctant to ask for help. There is huge pressure in the community, with a very violent stigmatisation,” explains the project coordinator.


*The names of the survivors have been modified