"That night, at around two o'clock in the morning, there was an attack on our village. Five armed men entered our house. I was there with my husband and children, but they caught me and took me to the bush. They made me lie on the ground and spread my legs.

Then, the five of them climbed onto me and raped me, until their needs were satisfied. When they were done with me, they carried me back to the village.

My house had been burnt in the attack and my children had fled. My husband was not there anymore and later we found his body in the bush. It was eight months ago, but I still feel intense pain in my chest and all over my body because of what they did to me."

32-year-old woman raped in March 2003

Until recently, there has been insufficient attention to sexual violence, although it has been one of the most serious consequences of the war and humanitarian crisis in Eastern DRC.

A Human Rights Watch report in 2002 highlighted:"Within the larger war in the Eastern Democratic Republic of Congo, the warring parties carry out another war: that of sexual violence against women and girls.(...) Sexual violence has been used as a weapon of war by most of the forces involved in this conflict.

Combatants of the Congolese Rally for Democracy, Rwandan soldiers, as well as combatants of the forces opposed to them - Mai-Mai, armed groups of Rwandan Hutu, and Burundian rebels of the Forces for the Defence of Democracy (Forces pour la Défense de la Démocratie, FDD) and Front of National Liberation (Front pour la Libération Nationale, FNL) - frequently and sometimes systematically raped women and girls in the last year." Human Rights Watch, The War Within The War, June 2002, p.1 

550 victims treated in 6 months

When MSF opened an emergency hospital in Baraka town, local women's associations reported that hundreds of women had experienced sexual violence in the area.

As MSF started its treatment for sexual violence, dozens of women - as well as several men - started appearing by the day for medical consultation. Since August 2003Until January 2004, time of writing of this report , more than 550 sexual violence victims have been treated by MSF in its hospital in Baraka.

The extent of sexual violence in Eastern DRC is not known, but these figures confirm that it runs into the hundreds, if not thousands.

The flow of people coming to MSF clinics who have experienced sexual violence persists today albeit at a diminished level.

MSF, however, keeps hearing reports of numerous victims of such atrocities who are still unable to access the clinic because of insecurity and the distance needed to be travelled.

Only now, when areas previously inaccessible because of the war are being opened up, is the true gravity of the problem of sexual violence in Eastern DRC becoming apparent.

"That day, one week ago, I was working in the fields with my husband and two other women. Suddenly, we saw a group of armed men approaching us. My husband managed to flee, but two men caught me and raped me. They hit me on the back and insulted me. I really thought it was death coming my way.

Since that day, I have terrible abdominal pain and often my head aches, especially when the whole story flashes back to my mind. I still haven't gone back to the fields since. I wouldn't go back there until there are no more armed men likely to do this to us.

But I have seven children and the fields are my only source of subsistence. Fortunately, my husband understands what has happened to me because he was there. He understands that I have been caught against my will.

However, I cannot help being invaded by shame - as soon as I go out in the streets I have the impression that everybody knows what has happened to me and my heart is pounding. I almost would have preferred to have been killed that day to escape from the shame."

35-year-old woman, October 2003

The story above is typical of the experience of sexual violence victims that MSF has spoken to.

In addition to treating patients, MSF has collected testimonies from women that were prepared to share their experiences. These stories provide an illustration of the dimensions of the problem.

More than half of the people who indicated where they had been raped said the incident took place in the fields whilst they were cultivating, usually with other people around them.

The attackers have usually consisted of a group of armed men who have caught them on the spot and sometimes brutally beat them up and raped them before leaving them lying on the ground.

Others said they were raped in their homes and a substantial number reported being raped in the bush where they had sought refuge when insecurity had led them to flee their homes.

Many women told MSF that they were attacked in front of their spouse, children, or family.

A 34-year-old woman who was raped in the fields and forced to witness her 15-year-old child being subjected to sexual violence described how: "As she tried to escape, they beat her up and broke her leg with a gunshot.

Three men raped her. I was so shocked, I so wished I could have prevented this from happening. She was still a virgin."

Sexual violence has not escaped men either. As this 45- year-old man explains: "It has been a year since this event, but I still suffer from the physical sequels of the rape.

Ever since then, I have been feeling intense pain on the left side; I have very strong headaches, and constant anal bleeding as well.

I cannot work anymore, I cannot even eat properly, but most of all, I don't have sexual strength anymore, I have become impotent."

A military strategy

The time when the rapes occurred ranged from February 2000 until January 2004, the time of writing of this report. There has been a clear correlation of incidences of rape with the level of insecurity in the area.

As many as 40 per cent of the patients who could indicate the exact date when they were attacked said that it was between January and August 2003 - a time when there was heavy shelling of the Baraka area and high levels of militia activity.

All armed groups have been involved in the widespread sexual violence.

The intent to terrorise, punish, and humiliate communities seen as supportive to the opposing side made rape a weapon of war.

Sexual violence has been so clearly linked to the military strategy of warring parties and has occurred in such a systematic way that it is wrong to think of it as a side effect of war.

In conflict situations women become more vulnerable and the normal restraints in society disappear as people are continuously displaced.

Even now with less fighting, sexual violence continues as the social fabric of the community is still in tatters and perpetrators of such acts are not being brought to justice.

The age of victims has ranged from girls as young as 12 years old to women as old as 70.

The youngest patient seen at the MSF clinic has been a 10-year-old boy who was raped by an armed man, while his mother was violated by two others. On many occasions, "gang rapes" have occurred with several men involved. More than 75 per cent of the people who mentioned the number of aggressors said it had been between 2 and 5 men at a time.

Five women treated by MSF had experienced multiple rapes - not once, but twice or even more. One woman even confided she had been raped three different times over the course of 3 years.

Most of the incidents of sexual violence have been committed with impunity. It is not clear whether there will be any justice for those victims.

As the next sections describe, the medical, psychosocial and socioeconomic effects of sexual violence persist for years if not a lifetime.

35-year-old woman, October 2003

The story above is typical of the experience of sexual violence victims that MSF has spoken to.

In addition to treating patients, MSF has collected testimonies from women that were prepared to share their experiences. These stories provide an illustration of the dimensions of the problem.

More than half of the people who indicated where they had been raped said the incident took place in the fields whilst they were cultivating, usually with other people around them.

The attackers have usually consisted of a group of armed men who have caught them on the spot and sometimes brutally beat them up and raped them before leaving them lying on the ground.

Others said they were raped in their homes and a substantial number reported being raped in the bush where they had sought refuge when insecurity had led them to flee their homes.

Many women told MSF that they were attacked in front of their spouse, children, or family.

A 34-year-old woman who was raped in the fields and forced to witness her 15-year-old child being subjected to sexual violence described how: "As she tried to escape, they beat her up and broke her leg with a gunshot.

Three men raped her. I was so shocked, I so wished I could have prevented this from happening. She was still a virgin."

Sexual violence has not escaped men either. As this 45- year-old man explains: "It has been a year since this event, but I still suffer from the physical sequels of the rape.

Ever since then, I have been feeling intense pain on the left side; I have very strong headaches, and constant anal bleeding as well.

I cannot work anymore, I cannot even eat properly, but most of all, I don't have sexual strength anymore, I have become impotent."

A military strategy

The time when the rapes occurred ranged from February 2000 until January 2004, the time of writing of this report. There has been a clear correlation of incidences of rape with the level of insecurity in the area.

As many as 40 per cent of the patients who could indicate the exact date when they were attacked said that it was between January and August 2003 - a time when there was heavy shelling of the Baraka area and high levels of militia activity.

All armed groups have been involved in the widespread sexual violence.

The intent to terrorise, punish, and humiliate communities seen as supportive to the opposing side made rape a weapon of war.

Sexual violence has been so clearly linked to the military strategy of warring parties and has occurred in such a systematic way that it is wrong to think of it as a side effect of war.

In conflict situations women become more vulnerable and the normal restraints in society disappear as people are continuously displaced.

Even now with less fighting, sexual violence continues as the social fabric of the community is still in tatters and perpetrators of such acts are not being brought to justice.

The age of victims has ranged from girls as young as 12 years old to women as old as 70.

The youngest patient seen at the MSF clinic has been a 10-year-old boy who was raped by an armed man, while his mother was violated by two others. On many occasions, "gang rapes" have occurred with several men involved. More than 75 per cent of the people who mentioned the number of aggressors said it had been between 2 and 5 men at a time.

Five women treated by MSF had experienced multiple rapes - not once, but twice or even more. One woman even confided she had been raped three different times over the course of 3 years.

Most of the incidents of sexual violence have been committed with impunity. It is not clear whether there will be any justice for those victims.

As the next sections describe, the medical, psychosocial and socioeconomic effects of sexual violence persist for years if not a lifetime.