(September 2010) A new study conducted in the eastern Democratic Republic of the Congo (DRC) has revealed that perpetrators and victims of high rates of sexual gender-based violence in the region include large numbers of both men and women and are associated with increased post-traumatic stress disorder and depression, as well as physical health outcomes. The study, co-funded by the U.S. Dept. of Defense’s Africa Command, the International Medical Corps, and McGill University, was published in the Aug. 4, 2010, issue of the Journal of the American Medical Association (http://jama.ama-assn.org/cgi/content/short/304/5/553).

These findings challenge the myth that women do not have the capacity to commit atrocities despite recent prosecutions for such crimes. Policymakers 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. National and international communities will need to develop and expand programs, policies, and protection strategies, including United Nations Security Council resolutions, to include male survivors and to address female perpetrators. Improved access to basic health care with a focus on sexual violence and mental health programs is needed on a large scale in eastern DRC.

During a PRB Discuss Online, Dr. Lynn Lawry, study author and senior health stability/humanitarian assistance specialist in the International Health Division/Office of the U.S. Assistant Secretary of Defense for Health Affairs, answered questions from participants about these new gender findings and including men and boys in combating sexual violence. This Discuss Online session was sponsored by the BRIDGE project, a cooperative agreement between USAID’s Global Health Bureau and PRB.

Sept. 29, 2010 12 PM EST

Transcript of Questions and Answers

aurelie mupepe: Which are the tracks of solutions which you recommend for the fight against violences bases on the gender in DRC? In addition to sexual violences, there exists other violences bases on the gender whose women are the authors as in the case when a wife loses her husband in the Congolese behaviour, it undergoes certain forms of ill-treatments on behalf of women of the family of her dead husband.
Lynn Lawry: Thank you, I agree with you that the violence in DRC is complex. We documented physical violence not related to conflict as well. In DRC, and based on our data, there appears to be a cycle of violence that is happening and has to be broken. Not only will programs need to address female and male survivors, they will need to address female and male perpetrators. On the preventive side, armed groups and communities will need more education about sexual and physical violence as well as the consequences of this violence. Behavior change is difficult and a long process but in the near future, groups in DRC will be designing a strategy for behavior change to address the societal problems you have highlighted.

Maakpe John Vianney: What can we do to change this pattern of behaviour among the men in Africa in terms of gender based violence? What is the root cause of this violence? Can it be attributed to cultural influence or as a traditional after going through our democracy?
Lynn Lawry: Thank you for this question. The study we did cannot answer all of these questions. These questions need a good qualitative study to look at these specific issues. Men are not the only perpetrators. We need to be sure that future studies do not limit questions about perpetration and the reasons why to just men. And, we need to understand that men are also survivors of sexual violence in the African context.

Issa Almasarweh: Why Congo? There are societies in the Middle East where gender-base violence is more prevalent. Women there are brutally beaten and humiliated every day by male family members to the degree that they believe beating is men’s right because they are too intimidated to seek help since they are scared to death from an easy divorce and often verbal divorce.
Lynn Lawry: We were asked and funded to look at violence in Congo. I cannot agree with you more about the Middle East. The issue is the funding to do these types of studies and the willingness of donors to fund a study as such.

Cletus Tindana: Gender based violence spreads like cancer especially when there are conflicts such as it is in Congo DR. It’s not surprising to hear that in some of these cases, there are women perpetrators. In this kind of situation, there is so much lawlessness and impunity because there is virtually no effective government to run the affairs of the state. What is the international community and other bodies especially the UN doing? It’s unacceptable that so many vulnerable people are put through this kind of atrocity. Why does it take so long for this “realisation?” i.e. the atrocities. Thank you.
Lynn Lawry: I appreciate your question and I agree. At the current time the UN has to assess its declarations and be sure they include protections for men and boys against gender-based violence and protections in conflict situations. The impunity is being addressed; however the process is slow to ensure fair justice. Our group is also looking more in depth at the atrocities which will be a publication at a later date.

Tope Akintunde: What are the causes of the sexual violence in Congo? If women are involved in the crime now can it be as a result of trying to gain freedom from a long time opression from the men? I am of the opinion that the causes should be looked into rather than the consequences.
Lynn Lawry: I agree with you. To assess causes or reasons why women are part of the perpetrator group requires a qualitative study. I don’t think any of us can state causes without a very good assessment. There are groups who have looked at this in a qualitative methodology which allows us to have a broader view of the context and issues within the social science literature. There are several disserations and studies currently on-going in DRC to address these specific issues.

Lanre Ikuteyijo: It is so interesting to note that female criminality is getting to the fore especially in terms of gender based violence perpetrated in conflict areas. Please I would like to know what theories could be used in explaining this rather unusual trend as well as the specific crimes women perpetrate against men; is rape inclusive (pardon my anxiety).
Lynn Lawry: Rape is included as perpetrated by women. As for the theories of why this happens; this is not my expertise. I would like to point out that this is not unusual. The International Criminal Court has successfully prosecuted women for sexual violence war crimes. Most of the literature as to female perpetrators is in the social science literature.

Dr. Anima Sharma: Gender based violence is very common all over the globe in one form or the other. It may be sexual abuse, molestation, exploitation, physical torture…any. Please let me know that what is different in Congo? There are so many programmes running all over the world but desired results are yet to be achieved. Right now I am travelling hence I have less time to focus but I will more like to know a fool-proof strategy to combat with this problem.
Lynn Lawry: What is different in the Congo is the rate of sexual violence committed by armed combatants (72% in our study). I agree that sexual violence is global. In DR Congo, however, the sexual violence that is most common is considered a war crime and not a crime of opportunity. Sexual violence in DRC is addressed by the newly signed National Strategy. The plan of action is comprehensive and includes all sectors of society to address this issue. Some of the most important documents can be found at the following: United Nations Mission in DR Congo. Comprehensive Strategy on Combating Sexual Violence in DRC: Executive Summary. Available at: http://monuc.unmissions.org/Portals/MONUC/ACTIVITIES/Sexual%20Violence/KeyDocuments/Comprehensive%20Strategy%20Executive%20Summary.pdf, Accessed March 20, 2010.Republique Democratique Du Congo Ministere Du Genre, De La Famille Et De L’enfant. Strategie Nationale De Lutte Contre Les Violences Basees Sur Le Genre (SNVBG), Available at: http://monuc.unmissions.org/LinkClick.aspx?fileticket=vTOe7bc8AME%3d&tabid=4073&mid=3978, Accessed March 20, 2010.Republique Democratique du Congo Ministere du Genre, de la Famille et de l’Enfant. Plan d’Action de la strategie nationale de Lutte contre les Violences Basees sur le Genre, Kinshasa, Novembre 2009. Available at: http://monuc.unmissions.org/LinkClick.aspx?fileticket=VxOTWqS%2b5lM%3d&tabid=4073&mid=3978, Accessed May 10, 2010.

Constance Newman: Would you please provide details about the nature of “reported sexual violence type” committed, by women and men, by the sex of their victims? For example, did women report personally raping or gang-raping boys/girls/ women/men, etc.
Lynn Lawry: We cannot answer for perpetrators. That was beyond the scope of the study. We can only describe the details of the sexual violence reported by survivors.

Kate Burns: What studies have been done on the motivations of sexual violence in DRC? Without better knowledge of motivations, how can prevention activities be very successful?
Lynn Lawry: There are a few studies assessing the motivations of sexual violence. To my knowledge, they have not been published as of yet and more are needed. I agree that we need to understand the motivations in order to look at prevention strategies. Complicating this is issue is the fact that US government supported programs cannot be used for prevention strategies that need to be addressed to armed combatants.

Josie Delap: What is different about the form that GBV takes in Congo to the way it has been used in other conflicts, e.g. Bosnia rape camps?
Lynn Lawry: The forms are not different around the world other than the prevalence of whether these were war crimes or not. In the case of DRC, and with 72% of the sexual violence committed by armed combatants, it is likely these constitute war crimes; similar to other conflicts.

Yewande Iwuoha,Producer Good Health: It is a shock to me that women have now turned out to be perpetrators of sexual violence. What could be responsible for this sad trend? This perhaps is of more importance to me. Is there a fast way out of this ugly and inhuman development?
Lynn Lawry: Yes, I agree. In the US, we were shocked to discover that women could be part of child abuse. Women have been convicted of sexual violence war crimes at the International Court, we know they are capable of doing this even though it goes against our paradigm of nurturing females. At some point we have to recognize that women are not above being perpetrators as well as survivors and find a way to address this. In my view, we need to look at women and men as a way to solve this, as men are survivors as well.

Laurie Krieger: How much of the violence by women is traceable to that part of Congo’s history as King Leopold’s personal holding and his “red rubber” kingdom? Is there any historical evidence that women’s violent behavior is not new in that area? If it is not new, how would you go about changing culture to help stop these practices, and which parts of culture would be most amenable to change?
Lynn Lawry: A very good question and not in my scope of knowledge. More work needs to be done to obtain this very important context.

MBONIMPA Gérard: I would like to know the different categories of gender-based violence that are most frequent in Togo. I am in charge of a database of gender based-violence.
Lynn Lawry: Thank you for your question. Types or forms of gender based violence are different in each country depending on the context and/or conflict. However, by using the United Nations definitions of SGBV, you can preload your database and ensure that surveys are asking complete data. Definitions can be found at: http://www.unfpa.org/emergencies/manual/4.htm  

Maggie: According to recent research from South Kivu, many rape survivors were actually attacked in the privacy of their own homes. Do you have any advice on ways in which peacekeepers can better protect citizens considering that numerous attacks take place in their own personal dwellings?
Lynn Lawry: Thank you for your question. I can’t answer this but I assume MONUSCO would have some suggestions on how best to address this.

Dr. Yasmin Siddiqua: The background of the study is of extreme interest no doubt. In Bangladesh gender based violence predominantly represents violence against women and the type includes both mental and physical. However, in some instances men in Bangladesh talk about violence against men, but this is mostly mental and not widely heard. Does the study really found violence against men which is physical? What is the root cause for that? In Bangladesh low social status due to gender discrimination limits scope for education, employment and life skills development for women which makes them vulnerable to physical and mental violence. In Congo, what keeps men in such a low social status that they become victim of violence? Having a detail understanding of the issue would really enlightened us with the new dimension of gender based violence for men.
Lynn Lawry: Yes, violence against men was physical. This is the same as what we found in Liberia as well. For most of the men the perpetrators were armed combatants during conflict or while associated with armed combatant groups. More research will help to determine the risk for gender-based violence among men and women.

Maggie: When women are perpetrators of violence, are they often the “direct” perpetrators? Are they more likely to coerce someone else to commit the violence on their behalf? If they directly commit the violence, is it more often alone, or is it a group of perpetrators? If so, is it a groups of females or males? Are female perpetrators more likely to be armed? Are there similar rates of female perpetrators both within civilian-based GBV, and GBV that has a specific connection to the conflict? Sorry for all the questions – the topic is just of such interest to me 🙂
Lynn Lawry: I wish I could answer each of your questions. We only asked survivors about who their perpetrator was and what sex the perpetrator was. In some cases of gang rape, mixed male/female groups were noted. Sexual violence in DRC was primarily conflict related so the female perpetrators were more likely to be associated with armed combatants in the areas we surveyed and over the last decade. The topic is more than interesting…I think it might be a piece we have been missing that will help us better program to break the cycle of violence.

Nancy Glass: I was in Goma when the study was published and read the results to Congolese colleagues (nurse, physicans, advocates, microfinance directors, etc) who have provided services to survivors of rape for approximately 15 years – there response to the findings was “These researcher mock us, now they are telling the world a lie” – How would you address these concerns by the Congolese who have worked with victims and have never had a women or man report rape by a woman?
Lynn Lawry: Thanks for this question. Even as a researcher, this was the first time I asked the sex of the perpetrator. In general, healthcare providers do not ask the sex of the perpetrator when questionning about sexual violence. I would urge them to look at this as another piece to a very difficult puzzle and rethink how we identify and treat survivors of sexual violence.

Erica: As the Congo gains more and more attention for the atrocities occurring, there has been an increase of funding to help rape victims. I’ve heard recently that some women have falsely stated they have been raped in order to receive monies. Has there been evidence of this, and if so how rapidly is it increasing?
Lynn Lawry: I cannot answer this from our data. There are questions about programs that are giving financial monies for survivors which on many levels may not be a good idea. We do know from our data that many survivors were pushed into community mediation by family where money was given as “justice” but the money went to the family and not the survivor.

Nancy Yinger: Did the police play a helpful role in assisting victims or did you find them to be perpetrators? Is anyone working with police to address gender norms that contribute to GBV in the Congo?
Lynn Lawry: Thank you for bringing this up as an issue. Police have been implicated in sexual violence. The UN (MONUSCO) is working with them on this issue.

Nancy Glass: Please provide the rationale for your definition of armed combatant? It appears that you are including women abducted and sexually abused as armed combatants?
Lynn Lawry: Thanks for your question. We use standardized UN or internationally accepted definitions for our work. In our study, a combatant was defined as any person who reported being part of any kind of regular or irregular armed force in any capacity, including but not limited to participation in combat, laying mines or explosives, serving as a cook/domestic laborer, decoy, courier, guide, guard, porter, or spy, trained or drilled as a combatant, or serving as a sexual servant or slave. Yes, this would include those abducted. We use the term to delineate those who fall into risk categories and therefore qualify for ex-combatant services.

Nancy Glass: You stated that the study was conducted in either Swahili or French – in many of the areas you interviewed – Swahili is that the languaged used – the population in the rural areas would speak Mashi for example in much of South Kivu – how did you address this in the study?
Lynn Lawry: The survey was conducted in Swahili. Several of the local data collectors were also certified to use other local languages if needed. We trained in French as that was the language the data collectors preferred to use.

Monique: Hi Lynn, could you share a little bit about your consultation/ discussion with groups on the ground, including those who are involved in providing direct access to survivors of (S)GBV during the process of designing the study as well as disseminating the findings?
Lynn Lawry: In all of our studies we meet with local providers, local leaders, USAID, donors, local and provincial ministry of health officials, the UN, NGOs, gender experts and survivors to inform the study. In addition, we conducted preliminary qualitative interviews as well as focus groups to help us decide what the issues were on the ground. After the study was finished, I was able to return to present the finding to all of the above listed groups as well. Currently, we are remaining available to groups to discuss findings and answer questions. We did so recently for implementer/coordination groups in Eastern DRC.

Steven Botkin: Are you aware of any men’s groups in DRC who are addressing gender-based violence?
Lynn Lawry: Thanks for this question. I am unaware of any such groups. Now that we have data, it would be great to address this gap in the hope of providing services for men who are not being addressed by current services.

Nancy Glass: I have worked in Eastern DRC for 3 years – in rural villages in South and North Kivu as a nurse and researchers. We have provided clinical care to male and female victims of rape and other violence as well as interviewed at least a thousand in conflict and non-conflict areas – we have never had a report of female rape of women or men – and we do ask? Why do you think your findings are so different from others and the experiences of local and international NGOs?
Lynn Lawry: I think it is great that you do ask and my hope is that others will. What is more imporatant than asking is the awareness that survivors have reported this, that rebel groups are using women to perpetrate violence and that we as a community need to develop remedies. Our study is population-based which is different from many if not all of the studies. In addition, we use one-on-one interviews that are anonymous and not in a care setting. However, in the social science literature there are very similar qualitative reports of the same results.

Jay Gribble: I realize that your research focuses on DRC, but if you were to speculate about GBV in conflict area in other countries, how different do you think they would be? If you think DRC is unique in this respect, any idea about why it is so different? Thanks!
Lynn Lawry: We have done these studies in many different countries (Liberia, Sierra Leone, Nigeria, Iraq, Afghanistan among others). To narrow the focus to Africa, I would say that some of the features are the same and some are different. In Liberia we found a similar rate of male survivors and numbers of ex-combatants. This was the first study we asked the sex of the perpetrator so we cannot compare the results regarding this data point. Overall, sexual violence is universal; however the rates, how it is used in conflict and the types vary country to country.

Kyle: can you explain what you mean by “rape”?
Lynn Lawry: We used internationally accepted definitions. To be concise this includes penetration of vagina, anus or mouth by an instrument or body part. Interestingly, there are some countries that do not count anal penetration or oral pentration as rape.

Kate Burns: Follow up question: I am concerned by your statement that the US Government does not surport prevention programmes targetted to armed actors. If a local organisation or faith based group wanted to hold awareness rasing and behaviour change work with armed elements — would this not be funded by the US. Or initating jobs creation or skills building for boys to get them out of carrying arms? Please explain what you intended by your answer
Lynn Lawry: Legally, USAID or US Government money cannot support any program that is done with armed groups. For more information, I suggest you discuss this with USAID. If the individual is an ex-combatant; by definition, they are now demobilized or civilianized and therefore are not considered a combatant. It is OK to work with ex-combatants.

Charlotte Feldman-Jacobs: Lynn, the study seems to have stirred up a hornets next among people that believe that female combatants should be viewed as victims and to view them as “perpetrators” doubly victimizes them. How do you respond to that?
Lynn Lawry: Yes, this is a hornet’s nest. Female perpetrators are not unknown and have been prosecuted by the International Criminal Court for Rwanda and Bosnia. We have societal views that women are nurturing and cannot be perpetrators but we also thought that women could not be murders or child abusers…we know that is not the case. My view is that we have to address this issue especially among rebel groups that are known to use women to perpetrate sexual violence. Ignoring this or ignoring that men are survivors will lead us down the same path we have already walked. It is time to come up with new remedies to an old situation. Perhaps recognizing this will allow us to break the cycle of violence. By not accepting that women and men in DRC reported female perpetrators or that men reported rape means we are not believing them. We have to at this point as we know from other studies that they exist. The only difference is now we know a number but that number can be used to our advantage as we can estimate the burden and appropriately program.

Nancy Glass: What has been the response of local Congolese NGOs – not international – to these findings?
Lynn Lawry: The overall response to these data has been positive. We had the chance to present the data in Kinshasa, Goma and Bucavu and our partners are continuing to present these data as we discuss this. Local NGOs and local healthcare providers found the data helpful and are working with International NGOs to come up with better referral mechanisms and behavior change programs.

Constance Newman: Could you please expand on your answer “Rebel groups are using women to perpetrate violence”? i.e., say more about the rebel groups and how they use women to pepetrate violence? Thanks,
Lynn Lawry: Our data showed there are two rebel groups who have female combatants that perpetrate sexual violence on both men and women. In our data, the Mai Mai were the most common group to do this. In discussions with Mai Mai leadership we found there are cultural reasons why female combatants are committing the sexual violence as opposed to male combatants. On-going qualitative work will help to define this better.

Deepali Patel: Are there any plans for follow-up studies or programs to understand and address this “cycle of violence” (particularly as perpetrated by women) in relation to providing opportunities for intervention or prevention?
Lynn Lawry: There are plans but no funding currently to do so. This is a much needed study.

Monique: Hi again Lynn, you have spent some time discussing the question of categorizing female armred combatants – both with Nancy and Charlotte’s. This is perhaps not so much a question as a comment – that perhaps we need to be particularly conscious of the situation of women who are enslaved or abducted – and forced to commit acts of violence. Not to ignore by any means perpetration of violence by women, but to look deeply at a) the context in which it is being perpetrated and b) most importantly, the potential stigmatization for those who have been abducted/ enslaved/ coerced and subsequently being named as perpetrators. Perhaps it is just a matter, as you suggest, of delving deeper via qualitative or other forms of questions to illuminate some of the context behind these numbers so that they are truly understood.
Lynn Lawry: Thanks Monique, I agree but we cannot ignore the female commanders in armed groups who are there willingly.