(October 2001) Wars and civil unrest are increasingly wreaking havoc on the lives of women and girls who often become refugees vulnerable to abuse. Wartime rape and other forms of gender-based violence remain a constant threat in politically unsettled lands. In countries such as Rwanda, where genocide erupted in 1994, rape has been used as an instrument of war to suppress and humiliate the enemy. The effects of such violence can be devastating and long-lasting and are a particular danger to a woman’s reproductive health. Women and girls who are subjected to sexual violence are at risk of contracting sexually transmitted infections, including HIV.

In the following interview with PRB, Judy A. Benjamin, senior technical advisor at the New York-based Women’s Commission for Refugee Women and Children, describes ways in which women and girls are at particular risk of HIV in situations of conflict. She draws from her own field research on refugees from two African countries — Rwanda and Sierra Leone.

PRB: How are the experiences of women and men are different in situations of war?

Dr. Benjamin: Conflict affects everyone in its path. Today, 75 percent or more of people killed or injured in wars are civilians. In World War I, fewer than five percent of all casualties were noncombatants. Although more men die in battle than women, women and girls are deliberately targeted for rape, torture, sexual slavery, trafficking, and forced marriages and pregnancies in conflict zones.

Conflict and post-conflict situations force changes in gender roles. As traditional caretakers of family members, women adopt coping mechanisms to secure basic human necessities for the survival of their families.

PRB: These women could be either international refugees who escape to other countries, or internally displaced people, who remain uprooted within their countries’ borders. Either way, they lack family planning and other reproductive health services. How difficult is it today to assess the links between conflict and HIV infection?

Dr. Benjamin: Today’s wars are more likely to be fought within borders rather than against invading forces or across borders. The civil war in Sierra Leone has created a population of nearly one million internally displaced people. Over 300,000 people are refugees in Guinea and in other neighboring countries.

Humanitarians, politicians, governments, and the media discuss the link between conflict and the spread of HIV/AIDS. However, quantifying that link is difficult because reliable statistical data are not readily available. Military forces do not publicize HIV infection rates of their troops even when statistics exist.

Rwandan Refugees in Tanzania

PRB: Let’s look first at your research with international refugees… Could you describe the project?

Dr. Benjamin: I directed an HIV/AIDS prevention program in Ngara, Tanzania, from 1994 until 1996 for Rwandan refugees. At that time, it was the world’s largest AIDS prevention effort for refugees. CARE was the lead agency, with support from Population Services International and John Snow, Inc.

The project initially targeted 67,000 refugees, but because of the enormous influx of refugees, that figure grew to nearly 200,000. The project used a community-based approach and a system of outreach by AIDS educators, selected and trained from the refugee population. At start-up, the project conducted a baseline survey to establish the knowledge, attitudes, practices, and beliefs regarding HIV/AIDS. After 12 months, the same survey was administered to measure the impact of the program.

PRB: How much awareness of HIV/AIDS and prevention strategies was there?

Dr. Benjamin: The baseline survey revealed a high level of AIDS awareness — 87 percent of respondents knew at least two ways to prevent HIV infection, one of which was condom use. Yet reported condom use was only 16 percent for men during their most recent sexual encounter. More than 50 percent perceived themselves to be at moderate or high risk for HIV infection. Given the high resistance to using condoms, other strategies were adopted, such as promoting fewer sexual partners and loyalty to one partner. Probably the most effective strategy was promoting aggressive sexually transmitted infection (STI) treatment and follow-up.

PRB: International attention has focussed on the violence these refugees faced. How were women and children particularly affected?

Dr. Benjamin: Rwandan women on both sides of the conflict were beaten, raped, and tortured. The violence did not end when the women arrived at the refugee camps. Rapes occurred frequently in and around the refugee camps. Women without adult men in their households were the most vulnerable. A number of women became pregnant as a result of rape during the conflict or in flight. Those who gave birth in the camps became pariahs. With no one to stand up for them, the unmarried mothers were easy targets for sexual abuse. They reported that men walked into their huts at will, raped them, and left.

The structural design of the camps led to gender violence when latrines and water taps were situated a distance from the dwellings. Women and girls were raped when they visited the latrine or fetched water. Self-appointed guards at the water taps demanded sexual favors from women seeking water.

PRB: How did you address this kind of violence?

Dr. Benjamin: The project addressed gender violence through counseling, through focus group discussions with men in the community, and by helping organize multi-agency crisis intervention teams (CIT) to assist rape victims.

PRB: Were there changes in behaviors?

Dr. Benjamin: The findings of the 12-month survey revealed that condom use did not increase. However, knowledge about HIV transmission modes improved. More people sought treatment and counseling for STIs after 12 months.

At the 12-month evaluation survey, women respondents were more sexually active than a year before (87 percent versus 79 percent), and more women had multiple partners during the previous two months (16 percent as compared to 2 percent during baseline). These troubling behavior changes, despite the aggressive AIDS prevention program, suggest that as the population in the camps increased and food supplies decreased women resorted to more sexual partners. Other analyses for this finding are also possible; the topic needs more research.

Internally Displaced People in Sierra Leone

PRB: Turning now to Sierra Leone and the protracted violence in that country … How do the experiences of international refugees compare with those of Sierra Leone’s internally displaced people — those uprooted people who remain in their homeland?

Dr. Benjamin: In many respects, internally displaced persons (IDPs) are more at risk than refugees are because they are not protected under the mandate of a specific UN agency. In addition to the protection of the UN High Commissioner for Refugees (UNHCR), refugees also have legal recourse under international refugee law.

Women in IDP camps face the same problems refugees do. Male food distributors cheat women on their food allocations and demand sexual favors in exchange for entitlements of food. Male hegemony prevails in camps through the UN system of appointing men leaders and decision-makers. Even though a few women leaders may attend meetings, the power is decidedly in the hands of men. The gender imbalance — significantly fewer women employed by the UN and nongovernmental organizations (NGOs) — perpetuates the disempowerment of refugee and displaced women and provides few opportunities for their voices to be heard.

PRB: What kinds of violence do women and children face at the Sierra Leone camps?

Dr. Benjamin: Gender violence in the camps, including domestic violence within households, is a major problem. The rebels and other military units inflict brutalities on civilians in their paths. The rebels destroy villages and capture young people. Boys are forced to fight and are given drugs that induce them to commit atrocities. If they refuse they are killed. Girls become sexual slaves or servants to the combatants. Some girls also become fighters.

The girls who have either escaped or been released by the rebels suffer extensive psychological trauma and multiple physical problems. Nearly 100 percent exhibit one or more STIs. In Bo, the YWCA assists former girl captives by providing counseling, one meal a day, and skills training. On arrival, the girls are taken to a clinic for a reproductive health checkup and treatments. Of the 99 participants present when I visited the facility, all 99 tested positive for sexually transmitted infections; most had multiple infections. Testing for HIV was not available but the caretakers suspected several cases based on their symptoms.

Crucial Issues Facing Refugee and Internally Displaced War-Affected Women and Girls

PRB: What were some of your general findings from the two projects?

Dr. Benjamin: In Sierra Leone, many women believe the long conflict engendered a culture of violence that permeates Sierra Leonean society. Rwandan women refugees expressed the same sentiment. War erodes traditional practices that promote respect and gender balance in societies.

Some of the crucial issues facing refugee and internally displaced women and girls include:

  • Inequitable distribution of resources within camps, despite having gender guidelines in place.
  • Women without adequate access to resources — particularly food — resort to coping strategies that put them at greater risk of HIV/AIDS.
  • UN agencies, governments, and religious institutions have been unsuccessful in protecting individual women and children in conflict settings.
  • Forced migration caused by conflict increases the vulnerability of women in every regard, but especially with respect to gender-based violence — rape, torture, abduction, forced marriage, slavery, trafficking, and forced pregnancies.
  • UNHCR’s mandate does not provide for the protection of individual refugees even though their policies describe various modalities for ensuring that the rights of women are protected. In practice, the institutional mechanism for enacting these policies is lacking.
  • Humanitarian assistance agencies do not see protection as part of their role. NGOs make assumptions that someone else will handle the problem.

Peace Keepers’ Role in Gender Violence and HIV Transmission

PRB: What of the role of UN peacekeeping troops sent into areas of conflict to restore and maintain order? These troops are comprised of contingents from countries around the world that are members of the United Nations. How do they help or perpetuate the problem of gender violence and the spread of HIV?

Dr. Benjamin: The skewed gender balance affects overall UN behavior and decisions throughout their operations. UN programs and implementation reflect the male perspective. Women’s needs in peacekeeping and peace making are given low priority.

The UN also needs to come to grips with the behavior of its soldiers in peacekeeping operations in relation to gender violence and prostitution.

Recommendations

PRB: Based on your research, what recommendations do you have for reducing the risks of violence and of contracting HIV that refugee women and children face?

Dr. Benjamin:

  • All peacekeeping and peace enforcement soldiers must be trained in international human rights laws, gender awareness and preventing gender violence, and HIV/AIDS safeguards.
  • UN mission staff must be gender balanced.
  • Violations and gender abuse must be exposed, and those responsible prosecuted to the extent possible.
  • Condoms and treatment for STIs must be available to troops, refugees, displaced people, and to local populations.
  • Donor agencies and governments should provide more funding to combat gender violence and HIV/AIDS.

For More Information

Living conditions for refugees are so chaotic that even where HIV prevention and care programs exist, the services are likely to collapse during emergencies. Read PRB’s article on factors that heighten the risk of HIV infection for displaced people and how relief agencies are responding. “Uprooted People and HIV/AIDS in Africa: Responding to the Risks”