Dr. Denis Mukwege

April 1, 2008

Testimony of Dr. Denis Mukwege Director,
Panzi General Referral Hospital Bukavu,
South Kivu, Democratic Republic of the Congo

Before the Subcommittee on Human Rights and the Law Committee on the Judiciary United States Senate

"Rape as a Weapon of War: Accountability for Sexual Violence in Conflict" April 1, 2008

Chairman Durbin, Ranking Member Coburn, and Members of the Subcommittee, it is a great honor for me to be invited to testify before this Subcommittee on the acts of violence against the civilian population in the Eastern DR of the Congo.

I thank you for accepting to take your precious time to listen to my testimony about the sexual terrorism that the women in the Eastern DR Congo have lived with for almost ten years. This is known by the national and international community, without anyone making a serious decision to end this shameful crime against humanity in the 21st century.

The word rape or sexual violence cannot fully translate the horror that hundreds of thousands of women are living in this part of the world. My testimony will refer to my daily contacts with these victims in the Hospital, and in the second part, I will illustrate this testimony by 3 typical cases symbolizing the thousands of women whom we treat.

It is important to point out that this sexual terrorism is done in a methodical manner and according to the armed group. Generally the victims are raped: -By several men at a time, one after another; -In public, in front of parents, husbands, children or neighbors; -Rape is followed by mutilations or other corporal torture; -Sexual slavery often goes on for months; -All kinds of psychological torture.

a)Complaints

On arrival at the hospital, women victims of sexual violence complain of:

On the physical level:

-Pain in the abdominal pelvic area -Vaginal discharge -Pains while urinating -Genital ulcers -Genital scars -Urine incontinence -Unwanted pregnancies
On the psychological level:

-Insomnia

-Nightmares -Palpitations -Fear of infection or of returning to the village -Lack of ability to concentrate
On the social level:

-Rejection by the family and by the community -Isolation -Destruction of the family cell -Loss of roots, loss of school attendance

b) Upon medical examination

On the physical level:

-Sexually transmissible infections, especially Chlamydia, which is a source of chronic abdominal pains and resulting in sterility. -HIV infection accompanied by opportunistic diseases

-Genital lesions from simple wounds to complicated genital lesions stopping urinary or digestive function such as urogenital and rectogenital fistulas, fibrosis of the vagina, etc.

c) Consequences to the woman:

1. On the physical level

? The destruction of her genitals by knives, guns, or abnormal deliveries destroys her future as a woman in everything that entails.

? Infection by sexual transmissible diseases, especially Chlamydia, which destroys her reproductive organs and her dream of having a child.

? Infection by HIV in an unfavorable environment for seeking medical care, along with opportunistic infections, which weaken her potential to be a responsible person, destroys her dreams for the future. It goes without saying that this woman, who has become incapable of fully using her capacities as a woman because any possibility of motherhood is taken away from her, and in addition is weakened by AIDS, looks forward in her pain to an easy death. However, we are all witnesses that this is voluntary murder.

2. On the psychological level

To be raped in front of: -Her husband -Her children -Her father -Her neighbors Deeply humiliates a woman. This brings on behavioral difficulties which can result in suicide, disinterest in living, lack of conscience, and aggressiveness.

3. On the social level These women are often rejected by their own family and their husband. This exclusion (isolation) can worsen the behavioral problems which were mentioned before.

4. On the family level This results in a break up of the family, and often the woman or girl victim is excluded and stigmatized instead of the rapist. The husband leaves, abandoning his wife (in her traumatic state) and children. The wife often seeks refuge and becomes internally displaced without any resources. Often, lack of protection and malnutrition finishes what rape started but didn't finish.

5. On the community level
-The destruction of potential mothers on a large scale -The spread of HIV on a large scale -The disappearance of the population without the capacity of renewal of the population

Hypothesis and Analysis

The analysis of this phenomenon shows that the rapists are not doing this to satisfy some kind of sexual desire, but simply to destroy the woman. This is demonstrated by the
following facts:

-If a woman is raped by men one after another, it doubles her chances of being contaminated by sexually transmitted diseases;

-Mutilations after rape open the skin, and she easily becomes contaminated by HIV;

-The systematic raping of women without regard to age - women 3 to women 80 years old - proves that the will to destroy the woman and her community is accomplished by infecting the woman who is the reservoir;

-The systematic destruction of the genital apparatus of the woman by infections, guns, knives, or abnormal deliveries demonstrates there is no sexual interest in the woman (otherwise she would have been protected), but rather the purpose is to destroy her reproductive organs to make her, her descendants, and the community disappear;

-Transmission of Chlamydia destroys the internal feminine genital apparatus and the woman becomes sterile. This desire to destroy pertains not only to the woman but to her whole family because:

-When a woman is raped in front of her children, she definitely becomes traumatized. Will her children who witnessed this and could do nothing, hearing the cries of desperation of their mother, be normal or abnormal? Will they or will they not be capable of respecting their mother?

-Mothers are dear to all children; I think that these children will have witnessed a scene that will leave marks on them for a long time.

-Men who witness the rape of their wives without being able to defend them, even if they live, develop guilt complexes, become afraid, and characteristically, they tell me that they become impotent. This turns into low self-esteem. They tend to leave the family to take refuge in a place where no one knows them.

-For the family and especially the children, it is a terrible thing to have a humiliated mother and a humiliated father who left them. Therefore, the cell of the community is totally destroyed.

This desire to destroy not only has an impact on the woman and the family, but also on the community because:
When the woman is destroyed, there is no possibility of a renewal of the community (the mechanism of renewal is broken);

In normal warfare, the men die at the front, but often the women reproduce children with some sick old men still alive. But the contrary is not true. When the uterus is destroyed, there is no possibility of reproducing. In the case of our species, when one destroys the genital apparatus, the men become useless, because they cannot reproduce children with sick women or women whose genital apparatus are destroyed.

10 healthy men can produce 1000 children if there are 1000 women. But 10 healthy women with 1000 healthy men can only produce 10 children under the same conditions. This analysis shows that man has been able to invent a horrible strategy of war which produces the same effect as a normal war (that is assassination, loss of property, occupation of land, internal displacements, and refugees with all the miseries that go with that) but worse yet, has an effect on the health of those concerned, with indelible marks that they will carry everywhere during their life span.

This situation is so much more serious because it does not concern ten thousand women, but rather several hundred thousand women.

I would like to take this opportunity to send out a cry of alarm in favor of these women on our planet who are not treated as well as men are, and who, most of their lives, are always in danger because of bad treatment or lack of treatment after being raped. Their social and economic reintegration in society and their compensation should not be neglected.

I am asking the national Congolese community to invest thoroughly in putting an end to this crisis, similar to no other, that is going on in Eastern DR Congo by using political, judicial, and whatever other means to isolate the authors of these crimes and stop them from committing any more crimes.

I am asking the International Community to make rational use of MONUC, the United Nations forces in the Congo, to protect the civilian population and especially women, which is part of their mandate, and yet this situation continues to this day.

I am asking the American government to use its influence on the governments of the countries of the Great Lake Region to stop this practice of rape being used as a weapon of war and to help stop the leaders of these horrible crimes, who are known to everyone; where they are staying is no secret, and their acts are known to everyone.

To complete my testimony, I am annexing 3 individual testimonies.

Testimony n° 01

My name is Madame Z, I am 26 years old, mother of 2 children and from Kaniola. On the night of December 15, 2005, at 11 p.m., some people speaking a foreign language broke my door down and came into my house. They had arms and machetes. Two of these men forced me to show where my husband was hidden. They tied him, and he looked on helplessly while the two intruders raped me.

They took all the members of my family and brought us in the forest. Eight of us walked through the forest for two days. In the middle of the forest they asked my older brother and my husband to sleep with my sisters. My brother, my husband, and my sisters refused and were all killed. I became a sexual slave in the forest. I had to serve each intruder sexually for a week.

They used me sexually and did to me whatever it pleased them to do. My horror lasted until the end of March 2006 when I escaped. Back in my village, my in-laws rejected me saying that I was the cause of the death of their husband and brothers. As I have no father or mother, I didn't know where to go. Some good people in the village who knew that at Panzi Hospital there was free treatment for raped women took me to a local association who referred me to Panzi. I ask that justice be done and that those people leave the forest in our country and go back to their own country.

Testimony 02

My name is Madame X and I am 47 years old. On the night of August 24, 2007, while we were sleeping, 4 intruders speaking another language, and probably from Kahuzi Biega Park, broke down the door of the house. They tied up my husband, stole everything in the house, and demanded money. Two of them raped me and the two others raped my 13 year old daughter and took her into the forest. When they first raped me, the second took a piece of wood wrapped in a piece of clothing and began to clean my private parts. In putting the piece of wood deeply in me, he wounded my bladder and my private parts. The next morning, the village people who had not run away took me to the dispensary. Two days later, a medical team from Panzi found me at the dispensary and took me to the hospital. I was treated and am now better, but I am afraid to return home because the intruders are still in the forest.

Testimony 03

My name is Madame Y, I am married, mother of 4 children, am 30 years old and come from Lubarika On March 8, 2008 at 10 a.m., an armed man dressed in military clothing and speaking Kinyarwanda surprised me in a field where I was planting. I wanted to run away, but he pointed his gun on me and threw me by force on the ground and put his hand my mouth fearing I would yell out. He put the mouth of the gun deep in my vagina and I became traumatized. I also realized that, after having the gun in my genital apparatus, I couldn't hold my urine, and it hurt a lot when I urinated.

The neighbor in the field helped me to get back to the village, and as I was bleeding a lot from the vagina, I went to the health center where they sewed me before transferring me to Panzi Hospital. I spent 3 weeks at the hospital. They repaired my urethra, which had been destroyed. Today I am cured, and I am preparing to go back home, but fear that my husband will reject me. I would like the hospital to accompany me home for family counseling in order to be reconciled with my husband.

These three testimonies represent the daily lives of these women in their homes, in the fields, coming and going wherever they are. We did not want to present more horrible testimonies to avoid emotional effects, but we have more than 10,000 indescribable testimonies.

Members of the Subcommittee, the eyes of these women are from now riveted on you. Their eyes will not leave you until you have actively taken steps to alleviate their suffering.

Thank you

Psychosocial Treatment of Women Victims of Sexual Violence at Dorcas House at Panzi Hospital The treatment is given on several levels:

1) The psychological level: the psychological treatment is done in two ways: listening to victims and psychological follow-up. By listening to the victim, the social worker tries to detect the degree of trauma. In many cases, the victims
want to be reassured that they are not contaminated by an incurable or sexually transmitted disease. If the victim is found to be in good health, her second concern is her social and economic reintegration in the community. She tries to empower herself and reintegrate into society.

For certain victims, it seems difficult to foresee total rehabilitation when one listens to their stories. Following are some examples of cases which we tried to treat and assist:

Mapendo Balagazi is 21 years old and has a one-year old daughter Anne-Marie. She witnessed a horrible spectacle - her husband's head was cut off in front of her in their house in Kaniola, and then he was castrated by the Interhamwe. They forced her to carry the bag containing the bleeding head of her husband into the forest where she was first raped by eight soldiers. After that, she had to cook the heads of their victims including her husband's as a meal for the Interhamwe. She does not admit to having swallowed the flesh, but she said that her friends fainted after swallowing pieces of human flesh. After three months, she escaped from the forest with the help of the Congolese army and the Red Cross. This is only one case among so many others. This woman suffers from serious mental and physical depression, including permanent anguish, phobia, loss of memory, and suicidal tendencies.

Emiliane Asemeke, who is 13 years old and from Shabunda, was returning from school at around 1 pm with three other teenagers (13 - 14 years of age). The Interhamwe soldiers met them and took them into the forest where they walked for three days. Emiliane was raped by five soldiers one by one. One of them took all her clothes, and the soldiers tore up her school books. She decided to escape after three weeks in captivity. She suffers from guilt feelings. At 13, she is a mother, the result of collective rapes. At first, she didn't want the child, and did not understand anything about being a mother. Thanks to the assistance of the nurse at Dorcas house, the child survived. She begged the girl to nurse her baby and take care of it, but had to feed him for her at the beginning with a bottle. Today the baby is living, after being hospitalized three times. The baby is gaining weight, and Emiliane has started to smile again. She has agreed to attend workshops at Dorcas House. She comes to get medicine at Panzi Hospital where the child is monitored by the hospital pediatrician.

We have many similar cases, and we try to make every effort to listen to them and assist them to end their pain and become normal again.

2) The social and economic reintegration level: it should be pointed out that all the women who come for treatment at Panzi Hospital do not live in the city of Bukavu. The majority of these women return to their respective villages, and there are quite a number of women who are seriously traumatized and who do not wish to continue to be helped. The hospital does all it can to assist local associations that treat and assist these victims in the long process of social and economic reintegration.

3) The emotional level: the victims need to be liked. They want to be reassured that everyone does not dislike them as their family members do. Gradually, certain members of their family decide to visit them at the hospital, and when they see that there are other women with the same problems receiving care, it makes them think again and change their attitude towards their relative. Certain husbands come to visit their wives and then go back in hiding. These husbands would like to live with their wives again, but are afraid of what others will say. A woman begged us one day to send a letter to her husband to reassure him that her HIV test was negative. She wanted to live with him again as a married couple. By asking her to remain in Bukavu and live alone, this meant to her that a woman has no status in society. She feels that nobody respects her, and the fact that she was raped is a terrible mark on her. However, she said that her husband promised to take her back again if she were not HIV positive. This woman left the hospital to find her husband, but we do not know if they are presently living together. The total destabilization of the community leads to its total destruction.

1. Testimony of Mme. Mapendo, 26 years old, mother of 2 children from Kaniola-Luya village. She was abducted and taken into the forest by her torturers from December 15, 2005 to the end of March 2006

Mapendo was married and lived with her husband, Mr. Bisimwa. The Interhamwe frequently came into their village at night to attack, loot, rape, and abduct women, so Mapendo and her family no longer slept at home. They slept in the banana leaves and in the fields a little farther away from the village. At that time, the intruders weren't coming there any more. Then on December 15, 2005, the family decided to sleep at home because the children had begun coughing from sleeping outside in the cold.

That night, Mapendo's nightmare began. At around 11 pm, they heard men ordering them to open the door. They broke down the door and entered with big lamps, with guns, machetes, and knives. There were ten of them and two looked at Mapendo and asked where her husband was. He came out of hiding trembling. They asked for dollars, but Mapendo and her husband didn't have dollars. She was grabbed and thrown on the floor. Two men raped her in front of her husband who was already tied up, while the other intruders took the 2 cows and 3 goats from the house. Mapendo and her husband were tied up and taken into the forest. While they were walking through their village, the intruders chased after other victims. The little sister of Mapendo's husband, who was married, was also taken away, as well as the oldest brother, the little brother, and the little sister of Mapendo while the dead bodies of their father and mother were left lying on the ground in their house. They were killed because they asked that the assassins leave 1 cow for them from the 6 cows that they took.

Eight people were tied up and taken into the forest on a very long trip which took 2 days. In the middle of the forest, things became more dramatic: the assassins asked Mapendo to lie down; they demanded that the oldest brother of Mapendo and her husband Mr. Bisimwa have intercourse with her in front of the others. When they refused, they were assassinated (their limbs were hacked apart) in front of the 6 other people looking on including Mapendo. They raped Mapendo again, and then they all continued their trip until they came to their camp in the forest.

Once in the forest, the assassins each took turns making Mapendo their sex slave for one week. Her sister-in-law and her little sister always looked sad, and were assassinated because of this, for the men said: if they escape, they will bring their Congolese brothers who will come to attack us. They didn't kill Mapendo because she didn't look sad. So Mapendo remained the sole woman with ten men who took their turn raping her. Each week Mapendo changed sex partners. She was watched constantly as the men feared she would escape. Mapendo realized she was pregnant at the beginning of February 2006. As the men saw that she had gotten used to them, they gave her a little freedom. She could go to fetch water a few kilometers away. She pretended that she was going to the brook, but decided that she was going to escape and return home to her village. As she didn't know which direction to take, she got lost in the forest for a week, ate leaves, and drank dirty water when she could find it. Finally, on the seventh day, she came to some fields where she met two older men who were cutting trees to make firewood.

They nearly ran away because she was almost naked; she cried out to them that she wasn't crazy, and they approached her. They were in a village very far away from Mapendo's village, towards Kalonge. The two men brought her to the village and gave her a loincloth to put on and food and showed her the route she should take from their village to return to Kaniola-Luya. So Mapendo continued on her route until the came to her village and stayed with her father-in-law and mother-in-law with their two children. When her in-laws saw her, they blamed her for the cause of the death of their son and daughter. As Mapendo didn't have her parents or her brother any more, she was obliged to stay with them, but they didn't get along, and they finally chased her away. Some good people took her in, and other people who knew about the treatment at Panzi Hospital for women like Mapendo, showed her a local association which brought her to Panzi.

Her condition when admitted to Panzi hospital

Mapendo was admitted to the hospital when she was three months pregnant, very thin and pale, unfriendly, wearing one loincloth with a torn T-shirt, very depressed, and accompanied by her two children, both suffering from malnutrition.

After two days, we chose her from among ten survivors picked to participate in a counseling group. Then she told us her story.
Presently, Mapendo lives with her three children (the last child was born as a result of rape) without a husband in her village and works in the fields. She makes her living working in the fields, and at the end of the day, she is paid and uses the money to feed her children. She is able to continue her life after the treatment she received at Panzi Hospital.

2. Testimony of a 12 month old baby

In January 2007, Panzi Hospital received a 12 month old baby girl. The parents of the child live in the Essence neighborhood in Ibanda Commune. The mother works at the market selling fresh sardines. The mother usually left her child with her neighbor when she went to work, but as the neighbor wasn't there, she took her child to her older sister in Kadutu.

Around 6 pm, the mother came back to get her child. She found the child on the back of her sister's male servant, Mr. Kulimushi. The child was sleeping. The mother gave Kulimushi a bag of fresh fish for having helped keep the child that day.

When the woman arrived home, her first gesture was to wake the child in order to put on a new diaper for she supposed that her diaper was wet. The moment the mother touched the child's thighs, the child began to cry. When the mother tried to undress the child, she saw that the diaper was wet with blood towards the child's anus but when she looked at the child's vagina, she saw more blood. She cried out, and the neighbors came running and quickly took the child to the nearest dispensary where it was confirmed that the child had been raped or the victim of sexual violence. The father arrived drunk towards 8 pm, and when he heard the news, he took a knife after his wife blaming her, saying that she was irresponsible to take his child to her family where they would hurt a 12 month old baby. The neighbors intervened to stop him.

Towards 5 am in the morning, the father took his wife and child to Kadutu, and they questioned Kulimushi intensely. The servant admitted that he had raped the baby. Later, he was taken to court and put in prison after the doctor's report at Panzi Hospital confirmed that the child had been raped.

State of the child when admitted to the hospital
This 12 month old baby cried and cried. When her mother tried to nurse her, the child was unreceptive, and all day, the child would not eat. The mother was very depressed, crying and saying that she was a living dead woman. She would not sit on a chair, but lay on the ground in the doctor's office. But, today, the child is well and family harmony is restored.

3. Testimony of Maman Faida M'Ciromo, 67 years old living at Mulamba-Ngweshe-Walungu

On February 25, 2008, Panzi Hospital admitted a woman who had been raped in the fields in 2007. She was hoeing; suddenly, in the forest she saw seven men dressed in military uniforms holding guns who suddenly ran into the fields. They cried out: "Put your hoe down" while pointing the gun at her. She began to tremble while they spoke in Kinyawrwanda. One of them asked for money. She replied: "I am a widow; where can I get dollars?" When they heard this, the attackers became angry. They said: "As you have no money, you must become our wife; we are going to rape you." She replied: "My children, I am only a widow and I am the age of your mothers, and I am your mother."

One of the seven attackers cried out: "And you, we are not discussing anything with you." Then he ran and kicked her, and she fell down. And so they began to rape her, one after the other. One lay down on her, the second raped her through the anus; the third made her open her mouth and put his penis in her mouth until he ejaculated in her mouth. When he wanted to put his semen in her mouth, he forced her by shaking her mouth to swallow the liquid. The fourth, fifth, and sixth raped her in the vagina, and they continued until all seven had raped her, leaving her half dead on the ground.

The woman stayed there until evening when she heard noises from some older men who were passing on the road which leads to the village. She cried out to them for help. They came and helped her, carrying her on their backs until they got to the health center where she was treated. Until this day, she has not forgotten that awful experience.

The state she was in when admitted to the hospital

The woman was very quiet and didn't want to say that she was raped. She only complained of nausea, digestive trouble, and especially constipation, gastritis and asthenia. However, on the second day she explained what really happened to her. After two weeks of treatment at the hospital, she was back to normal. This woman is now well and living at Ngweshe as a widow.