Commitment or appearance? Tackling
Conflict-Related Sexual Violence in the
Central African Republic
Master Thesis in Crisis and Security Management
Faculty of Governance and Global Affairs
Leiden University
Inês Guerra Nunes Student 2554569
Supervisor: Dr. Jelle van Buuren Second Reader: Dr. Joery Matthys
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Acknowledgements
I would like to thank my supervisor, Dr. Jelle van Buuren, for all the understanding and availability to answer my doubts throughout the entire process of my thesis – your guidance, suggestions and calm were sincerely appreciated.
Thank you also to Dr. Tiago Maurício, who supervised my internship in the Portuguese Ministry of Foreign Affairs in 2018, for your suggestions in regard to my research on the United Nations and MINUSCA. The time you have taken to assist me, also when I first applied to this Master programme, is something I am genuinely grateful for.
To my parents and my brother, for all the unwavering support and trust given to me since ever, but especially during my time in The Hague and the – more stressful – months spent back home, due to Covid-19 pandemic. Thank you for always pushing me to do more and better, however allowing me to take my time and pursue what I love.
To my friends back home, who have been present in so many crucial moments of my life already. It is great to have you around for one more.
Finally, to Rodrigo, for his companionship, for listening to all my doubts and comments along the way, and for always being ready with suggestions and motivation words.
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Abstract
Sexual violence has been used as a weapon of war ever since war exists. However, only recently it was recognized as an “stand-alone” issue by the United Nations, who now has specific mechanisms in place to tackle this problem. In the Central African Republic, religious, political and societal clashes have led to the spread of this reality, with perpetrators targeting mainly women and children of another religion and/or political affiliation. Due to the stigma around conflict-related sexual violence, many victims do not come forward about what the attack, neither do they seek medical assistance. In their daily job in the Central African Republic, the UN and non-governmental organizations working on this matter operate towards reducing CRSV incidence. However, this is not without difficulties, facing problems that complicates their work, being challenges to implement their “best practices” or external matters that constraints their action on the ground.
Keywords: Conflict-Related Sexual Violence; CRSV; armed conflict; Central African
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Content
List of Abbreviations 5
Chapter I
1. Introduction 6
1.1. Academic and societal relevance 7
1.2. Reader’s guide 7 Chapter II 2. Body of Knowledge 9 2.1 Conceptualization 9 2.1. Literature 10 2.2. Expectations 15 Chapter III 3. Methodology 17 3.1 Conceptual model 17 3.1. Case Selection 18
3.2. Research Design and Data Collection 19
3.3. Data analysis and measurement 20
3.4. Limitations 21 Chapter IV 4. Case description 23 Chapter V 5. Empirical Findings 30 5.1. An holistic approach 30 5.2. Training 37
5.3. Engagement with communities: raising awareness 40
5.4. Political will 46
5.5. Funding 49
5.6. Human Rights, Justice and Accountability 51
Chapter VI 6. Analysis 56 Chapter VII 7. Conclusion 60 Chapter VIII 8. Reflections 64 References 67 Annexes 75
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List of Abbreviations
CAR – Central African Republic;
CRSV – Conflict-Related Sexual Violence; GBV – Gender-Based Violence;
HRW – Human Rights Watch;
ICRC – International Committee of the Red Cross; IRC – International Rescue Committee;
MINUSCA – Mission Multidimensionelle Intégrée des Nations Unies pour la Stabilization en République Centrafricaine (in English, United Nations Multidimensional Integrated Stabilisation Mission in the Central African Republic);
MSF – Médecins sans Frontiéres (in English, Doctors Without Borders); NGO – Non-Governmental Organization;
OCHA – Office for the Coordination of Humanitarian Affairs; OHCHR – Office of the High Commissioner of Human Rights; PKO – Peacekeeping Operation;
SCC – Special Criminal Court; UN – United Nations;
UNFPA – United Nations Population Fund; UNICEF – United Nations Children Fund; UNSC – United Nations Security Council; UNSG – United Nations Secretary General.
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Chapter I
1. Introduction
Sexual violence has been used as a war weapon since war exists. From rape to sexual slavery, forced pregnancy/sterilisation or enforced prostitution, only since the end of the 20th century conflict-related sexual violence (CRSV) has been considered and evaluate under international law as an issue on itself, leading to progress in how “systematic rape and other forms of sexual assaults against women” is dealt by agents and organisations (Fanande, 2010:24). It has been widely proven that CRSV causes severe repercussions on victims and their communities, physically and psychologically – impacting, on its extreme, the very continuation of a group, as recognized on the UN Convention Against Genocide if, on a certain occasion, it falls under the acts pursuant to its article II (a)-(e). It is thus an extremely relevant topic to deepen. Consequently, I propose looking to practical aspects of how CRSV is treated and dealt with locally.
To this end, this research will use as a case study the Central African Republic (CAR), where religious, political and societal clashes have led to bloodshed and armed conflict since 2013. Regardless of the United Nations (UN) Peacekeeping Operation’s creation in 2014 – the United Nations Multidimensional Integrated Stabilisation Mission in the Central African Republic (MINUSCA) –, it remains one of the most forgotten contemporary conflicts. Both Human Rights Watch (HRW) and the United Nations Office of the High Commissioner of Human Rights (OHCHR) have noticed how sexual violence is used as revenge in case the victim supports “the other side”, thus being targeted due to their religious affiliation. Nonetheless, although rarely mentioned in the media, several developments have taken place and policies have been implemented to tackle CRSV in the CAR. Therefore, I will proceed to an analysis from 2014, since MINUSCA was implemented, until April 2020, in order to include recent information on the matter. Later in this thesis, the case will be further explained. Taking this into consideration, I pose the following research question: “What challenges do the United Nations and non-governmental organizations face when applying what in the literature has been defined as best practices in the fight against conflict-related sexual violence in the Central African Republic since MINUSCA began operating?”.
7 This research demarks itself from more general occurrences in armed conflicts, focusing rather on CRSV consequences, how it is planned to be fought locally and which challenges are being dealt with, through international mechanisms and policies to local, regional and international cooperation. All in all, this study will allow a better understanding of how CRSV consequences and the obstacles on the ground affect the effectiveness of the mechanisms in place and how these setbacks are faced by those committed to help the victims and, ultimately, the victims themselves, who live CRSV consequences.
1.1. Academic and social relevance
This research is highly connected to crisis and security management as it approaches a giant and often hidden reality of armed conflict that tremendously impact victims, communities and countries, during and in post-conflict settings. This is why although Fanande (2010:14) mentions that current CRSV studies “tend to remain on the problem of wartime rape; the employment of that act as a weapon of war; and the consequential outcomes”, I propose going a step further. By researching within the literature of sexual violence, conflicts and capacity building of local communities, it becomes possible to analyse the actual results achieved and obstacles in the way of an efficient and effective enforcement of the mechanisms and policies created by the UN and NGO’s focusing CRSV. As a consequence, this research’s results will lead to an understanding of the international organisations’ framework on CRSV, and whether these are up to date and efficient in tackling the problem or if there is the need for adjustments to provide a better intervention and support of victims, providing also fruitful outcomes to policy-makers and humanitarian aid workers.
1.2. Reader’s guide
In the next section, I will proceed to a conceptualization and analysis on the existing literature on the topic, constructing a framework to approach later on. This will allow me to understand the common ground shared by different scholars, together with deeper explanations and challenges that CRSV continuously faces. Following this, the methodological chapter will present the steps taken – namely data collection and processing, as well as its analysis –, together with a description of how I will work on the information gathered. It will be followed by a description of the current CRSV situation in the Central African Republic, where I go
8 deeper on the reasons of the conflict and on the reality of conflict-related sexual violence experienced by victims in the country.
Afterwards, I will present the main findings on the UN and NGO’s “best practices” and problems identified in the literature, which precedes an analysis on the information collected on that regard. A conclusion will follow this analysis, answering the research question posed above, being subsequently presented some reflections on data encountered during the research but do not relate to the research question, as well as some recommendations for future approaches on the matter. Overall, I will approach the following research by the methodology of “program theory”. This means that I will map, based on literature and insights from the mentioned actors, what are considered to be “best practices” in fighting conflict-related sexual violence. Next, I will compare these best practices with what actually happens in practice, to establish whether or not best practices are implemented, and if not, what apparently are the challenges blocking the implementation of best practices. I will specifically look at challenges mentioned in the literature as potential blockades, but will also look for other, new explanations for a potential mismatch between best practices and actual practices.
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Chapter II
2. Body of Knowledge
In this section, I will begin by conceptualizing the main terms which will be applied throughout this research. Afterwards, an analysis of the existing academic literature and organization’s “best practices” will be addressed. Then, a summary of the main obstacles that inhibit an effective application of the latter will be identified.
2.1. Conceptualization
According to the World Health Organization (WHO), sexual violence involves unwanted sexual advances or attacks on a person’s sexuality through coercion. Although rape is what most immediately comes to mind, such actions also include, among others,
“sexual abuse of mentally or physically disabled people [and] children; forced marriage, [the] denial of the right to use contraception or to adopt other measures to protect against sexually transmitted diseases; forced abortion (…) female genital mutilation and obligatory inspections for virginity [and] forced prostitution” (WHO, n.d.:149).
Far from an accident of war, conflict-related sexual violence is often used as a military strategy, differing from peacetime sexual violence as it is “aggravated by ethnic, religious, or ideological cleavages that increase the level of hatred and brutality” (Koos, 2017:1936)1. As a consequence, it is often linked to torture, the use of objects and raping in public spaces. Gang rape also highly increases during wartime, from 2-27% to 70% (Koos, 2017). Ultimately, CRSV relates to the “humiliation of communities, the creation of terror and the spread of disease”, being enforced by both state and non-state actors (Koos, 2017:1936)2. All in all, conflict-related sexual violence has currently legal consequences, being considered a crime against humanity when “committed as widespread or systematic attacks against the civilian
1 Records often show “mutilating women’s breasts or genitalia; ripping open the stomachs of pregnant women to
kill fetuses; inserting foreign objects such as rocks, knives, or burning wood into the vagina; firing guns into the vagina; and abducting survivors, particularly young girls, as captive “wives”” (Pruitt, 2012).
2 OHCHR’s report on the conflict in the CAR “describes human rights violations and abuses predominantly
10 population”, qualified as a war crime when “linked to an armed conflict” and as genocide when “perpetrated with the intent to destroy a national, ethnical, racial, or religious group” (Mukwege Foundation, 2019:9). There can be of course overlaps – for instance, a genocide often happens during armed conflict. This is why each case needs to be evaluated as such.
2.2. Literature
Testimonies have made clear the dramatic consequences on CRSV long ago, from sexual transmitted infections, broken bones, unwanted pregnancies, wombs which fell out during gang rapes, infertility, traumatic fistulae caused by vaginal/rectal torture, amputations, migraines, post-traumatic stress disorder (PTSD), depression, apathy, sleep disorders, self-loathing, anxiety, psychosis or even suicide. Social rejection due to stigma is also extremely present, often resulting in victims being shunned from their communities, losing their value as humans due to the embarrassment they cause to their families communities due to what happened to them (Fanande, 2010; Koos, 2015; Nettles, 2017; Pruitt, 2012; Spangaro, Adogu, Zwi, Ranmuthugala and Davies, 2015). This loss of their support network, together with their form of livelihood, may lead to economic constraints (Pruitt, 2012). Many survivors are also “unable to access essential medical care, psychosocial support, and other vital services, or reluctant to do so given the stigma and culture of silence pervasive in the country” (The New Humanitarian, 2014). This way, CRSV survivors may be faced with a loss of their socio-economic support, health risks, trauma and lifelong complications.
Nevertheless, several scholars concluded CRSV is not inevitable in conflict, thus strengthening the need for preventive actions (Fanande, 2010; Nettles, 2017). After a long struggle for international acknowledgement, various programs have been created to assist CRSV. Spangaro et al. (2015) mention initiatives to economically support victims, community mobilisation leading to awareness and protection, care systems for survivors, among others. Actors on the ground have been incorporating several of these approaches, resulting in “multiple-component interventions”.
There has been an increasing awareness of how a “multi-component approach”, or holistic approach, is the best option when it comes to CRSV victims. Centered on the survivor and his/her needs, it allows to tackle the broader sphere of issues brought by sexual violence
11 episodes, consequently easing CRSV survivor’s re-integration in society. A multi-component approach calls for assisting CRSV victims in more than a physical and medical way, including psychological help, legal assistance and socio-economic reintegration activities, for instance. The reason behind this logic is that, as understood by now, CRSV frequently lead not only to the destruction of victims’ bodies, but also “their spirits are broken, relationships with loved ones are troubled, and their capacity to carry out livelihood activities is substantially reduced” (Mukwege Foundation, 2019:5)3. Hence, it is vital to address these issues as a whole. By approaching victims as survivors, and by enforcing a compassionate care of patients, professionals push for a faster and more complete healing.
The UN itself recognizes nowadays CRSV as “an explicit (stand-alone) designation” (Report of the United Nations Secretary-General [UNSG], 2019:48), mainly through Resolutions 1325 (2000), 1820 (2008), 1888 and 1889 (2009)4. By incorporating CRSV as a separate issue on UN Peacekeeping Operations (PKO) and creating the Office of the Special Representative of the Secretary-General on Sexual Violence in Conflict (2010), the UN aims to ensure CRSV is monitorized by experts which, through their investigations, report and recommend on “incidents, patterns, trends and perpetrators” (Report of the UNSG, 2019:48)5.
3 “Though her body began to heal, she remained immobilised in her bed – not wanting to move, speak or eat. We
came to learn that this woman, a grandmother, had been raped in front of her entire family. She felt immense shame and social stigma from this experience – so much so that the repair of her body was seemingly insignificant without addressing her other needs” (Mukwege Foundation, 2019:5).
4 Respectively, these address the “disproportionate and unique impact of armed conflict on women, [stressing] the
importance of women’s equal and full participation as active agents in peace and security”
(https://www.peacewomen.org/SCR-1325); sexual violence as a weapon of war
(https://www.peacewomen.org/SCR-1820); call for a Special Representative on sexual violence in conflict and
establishes Women Protection Advisors (WPAs) “within peacekeeping missions”
(https://www.peacewomen.org/SCR-1888) and call for “the development of indicators to measure the implementation of SCR 1325” (https://www.peacewomen.org/SCR-1889).
5 These results will in turn exert “pressure on individuals, entities and parties, through the adoption of targeted
12 The UNSG thus recommends a multisectoral approach to improve assistance to survivors, namely through medical, psychosocial and legal services6. Guterres also underlines the importance of continued training of peacekeepers, including “in situ, context-specific scenario-based training and early-warning preparedness” (Report of the UNSG, 2019:50). Training can also be useful for journalists, human rights defenders and civil society actors – such as women’s organizations and community leaders. Not only do they work to enforce prevention measures, but they also help campaigning to raise awareness and fostering safety and ethics when working and reporting on CRSV, being sensitive to victims’ needs (Report of the UNSG, 2019; Pruitt, 2012). The involvement of religious and traditional leaders is also encouraged as they play an important part on community’s lives.
In the CAR, some results are already being seen. With the support received from the UN, “83 community-based protection committees [and] 109 protection networks were established”, with several women receiving training on “psychosocial care for survivors (…) and to facilitate referrals to relevant service providers” (Report of the UNSG, 2019:12). This led to 80% of CRSV reports to the UN and its partners receiving clinical and psychosocial care. The UNSG underlines the importance of an higher economic support, together with technical expertise, to enhance military justice institutions’ capacity and creating “specialized units within the police” with a strong presence of women – “given the positive correlation between the percentage of female officers and the reporting rates for sexual violence crimes” (Report of the UNSG, 2019:52). The CAR has been making efforts to fully operationalize a Special Criminal Court (SCC), which includes both national and international prosecutors and judges and has
individuals who commit, command or condone sexual violence, consistent with international criminal law, whether military or civilians” (Report of the UNSG, 2019:48).
6 Including a “comprehensive sexual and reproductive care such as access to emergency contraception and safe
termination of pregnancy and HIV prevention (…) as well as reintegration support for survivors, including shelters, [with special attention to] ethnic or religious minorities; women and girls in rural or remote areas; those living with disabilities; female heads of households; widows; male survivors; women and children associated with armed groups; women and children released from situations of abduction, forced marriage, sexual slavery and trafficking by armed groups; children born of wartime rape; and lesbian, gay, bisexual, transgender and intersex persons, who may require specialized responses” (Report of the UNSG, 2019:52).
13 “authority to try grave crimes committed during the country’s armed conflicts since 2003” (Human Rights Watch, 2019a). Although it was legally established in 2015, it only started its first investigations in 2018, when the national Parliament “adopted its rules of procedure and evidence” (Human Rights Watch, 2019a).
A joint rapid response unit that tackles prevention of sexual violence against women and children (l’Unité Mixte d’Intervention Rapide et de Répression des Violences Sexuelles Faites aux Femmes et aux Enfants) was also created, redirecting its cases to the SCC. Nonetheless, many of these implementations are completely subjected to governmental will. Despite an increased trust of survivors in the criminal justice system, a lot has yet to be done since, in 2018, from the 320 CRSV cases “submitted by the Unit to the [SCC], few had resulted in trials” (Report of the UNSG, 2019:12). Although successful actions have been taking place, such as joint operations between the UN police and the Internal Security Forces of Bossangoa (a central region in the country), e.g. the Unit’s first investigation outside of Bangui in November 2018, the government’s national budget resulted in its unsustainability.
The United Nations thus still face several problems regarding their actual approach. Issues such as training in need of improvement, lack of awareness, political will and funding, as well as a cooperation between the UN and NGOs that always has space for improvement, cause a limitation to the efficiency and efficacy of policies and actions that are very promising on paper. The UNSG wants to make available all the necessary resources to monitor, analyse and report CRSV, considering it
“a tactic of war, committed as possible crimes against humanity, or war crimes, as a constitutive act with respect to genocide [and] a tactic of terrorism, as well as [when is] used as part of the repertoire of violence targeting [specific people] on the basis of perceived political affiliation or ethnicity” (Report of the UNSG:50).
The increased UN fight against CSRV is noticeable throughout different actions – from country-specific resolutions or (renewals of) mandates of peace operations, e.g. – and by recognizing it as a risk both for displaced persons but also as a displacement tactic in the first place. Nonetheless, the UNSG insists these actions ought to systematically have a survivor-centered focus, respecting their “safety, confidentiality and informed consent”, providing a
14 safer environment and proper assistance services (Report of the UNSG, 2019:50). This will also affect the training provided and mentioned above.
The failure of a proper UN funding has however been a recurrent blockage to an effective action, preventing the development of civil society groups that “enhance informal community-level protection mechanisms” (Report of the UNSG, 2019:50). Such setbacks (mainly, lack of funding) are often tied to governments’ attention on the topic. Like so, the higher the political will for change to happen, the more likely it will actually happen. Throughout the international peace agreements that follow conflicts, the international community only rarely mentions sexual violence, meaning it does not recognize “the matter as an international concern”, untied to the peace process (Pruitt, 2012:303)7. To Pruitt (2012), this turns international actors complicit, as they indirectly support the perpetrator’s impunity, undermining prospects for lasting peace. Also the UNSG sets the reminder that even “governments that are vocal advocates fail to back their words with action” (MINUSCA, 2019b).
With regard to NGOs, the International Rescue Committee (IRC), as one ofthe most relevant on the ground, has developed a significant role on the process. Its emergency response holds as priority “the provision of services to meet the health, psychological and safety needs” of survivors, providing “crisis counselling and referrals to health services” (Mora, Roesch & Poulton, 2014:26)8. Even so, local organisations also require knowledge to provide assistance, leading IRC to value partnerships and capacity-building of women’s grassroots organisations, although facing an occasional resistance from several donors that consider this a low priority during “acute crises” (Mora et al., 2014:27). This idea of cooperation meets the UN logic mentioned above, and throughout time the latter has been increasing its cooperation with
7 “Of 300 peace agreements occurring since the Cold War’s end, only ten mentioned sexual violence at all” (Pruitt,
2012:303).
8 Where large health centres existed, these services were embedded “within health structures to minimise visibility
15 governmental organizations in its PKOs9. Similarly, by analysing IRC’s approach one can also understand it is taking similar steps.
Relationship strategies between organizations can go from coexistence to cooperation. The former is enacted when there are “no common goals to pursue and actors merely operate side by side” (MINUSCA, 2017b:25). Here, the focus should be minimizing inter-organizational conflict and competition, leading rather to the different organizations working “in the same geographical area with minimum disruption to the other’s activities” (MINUSCA, 2017b:25). On the other hand, cooperation should be pursued by organizations with common goals. Among others, they can do so by agreeing on working together, forcing a joint strategy between military and humanitarian actors (MINUSCA, 2017b). Overall, “coordination should focus on improving the effectiveness and efficiency of the combined efforts to serve humanitarian objectives” (MINUSCA, 2017b:25).
2.3. Expectations
As seen, CRSV is a thematic whose relevance was disregarded for too long, as only recently it overcame its struggled for recognition. By finally receiving credit by the UN, one can see how the most relevant international organization worldwide has begun to relate to the topic. It remains however an extremely sensitive area for people to mention and work on (politicians and humanitarian aid workers, e.g.), having a too big of a diversity in problems to face. Despite all, it is crucial to grasp what these entities feel block their action the most when assisting CRSV victims in the midst of an on-going conflict. Hence, I expect to find some irregularities regarding pledges on paper, compared to their actual enforcement. Nevertheless, since CRSV has been receiving more international attention, I also anticipate to find recent developments and improvements both on international organizations and NGOs that dedicate themselves to this cause.
The focus of this thesis will thus be an analysis of the best practises and problems identified in this chapter. The former is characterized by the necessity of a survivor-centred focus with an
9 Pruitt (2012:315) supports the creation of a joint training between the UN Women and Peace Security with “local
16 holistic approach (physical, psychological and economical support as the minimum standard to be ensured), better and continuing training of actors on the ground on the issue of CRSV and raising awareness on the problem and educating on the ethics necessary when working on it. Every aspect just mentioned, however, is only as strong as the cooperation between different agencies and actors on the ground is, and so this aspect is also vital to ensure an effective application of the best practices identified. On the other hand, the main problems identified – which negatively affect the best practices just mentioned – are a lack of political will and commitment to give CRSV the (inter)national political attention it deserves, which in turns affects the funding directed to the situation. The reason behind approaching CRSV through all these different “fronts” individually is how it allows the identification of problems and challenges brought to the surface with each action.
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Chapter III
3. Methodology
This section will focus on the methodology that will be pursued, justifying the selection of this specific case study. The study’s design and data collection will also be addressed, followed by how data will be analysed, measured and operationalized. The section ends with the analysis of the research’s limitations, with considerations on its validity, reliability and generalizations.
3.1. Conceptual model
As mentioned, this study aims to analyse the obstacles that the UN and NGOs face on the ground in the Central African Republic when fighting CRSV. Their actions are laid down in legal documents, agreements, plans of action and media and field reports, all interacting and modifying each other – together with the limitations mentioned above. All these actors relate to each other in a relationship which has an effect on the effectiveness on the organizations, “tempering” with their actions. This way, based on the literature and insights from the organizations, I will proceed to identify what they determine as their “best practices” in the fight against CRSV. Afterwards, by comparing these best practices with what happens in practice, it becomes possible to establish whether the former are implemented or not. If not, I will establish what the apparent challenges blocking their implementation are. Likewise, although the literature will allow me to establish possible blockades, I will also look for other, new explanations for a potential mismatch between best and actual practices.
Specifically, the “best practices” I will focus on are the holistic approach that should be provided to CRSV victims, specific training that organizations’ personnel should undergo, awareness-raising, the political will both from the international community and national government, the funding allocated and the focus given to Human Rights, Justice and Accountability. Within the continued training of peacekeepers that is planned, for instance, I will analyse UN field reports to see whether such trainings are being incorporated on the ground and, if so, study if the results are being the ones expected. This qualitative research studies whether such mechanisms are efficient and effective or not, reviewing them and developing an in-depth analyses of the blockages faced with their application.
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3.2. Case selection
As I plan to research on conflict-related sexual violence, my case study requires covering sexual violence in a conflict setting. By focusing on the Central African Republic, my analysis fits Yin’s (2018) rational of a representative case of CRSV, being a typical situation of the phenomenon. Nevertheless, the current CRSV problem in the country is also a pragmatic, self-explanatory case, with too many testimonies and work done on the matter that proves the existent reality. The two main factions of the conflict causing instability, the Christian anti-balaka militia and the Muslim Séléka rebel coalition, have left nearly 2/3 of civilians dependent on humanitarian aid and were identified as the main perpetrators of CRSV (MINUSCA, 2018; Office of the Special Representative of the Secretary-General on Sexual Violence in Conflict, n.d.; UN News, 2019)10. The dialogue and joint action that this issue calls for is however only effective if real action is enforced through a fruitful relationship between the UN agencies, organizations and donors, together with working with “survivors, affected communities and [local] women’s organizations” (Report of the UNSG, 2019:50).
On a more personal level, French is fairly easy for me to understand due to its Latin basis (my mother tongue being Portuguese). I am also already familiarized with MINUSCA as I worked extensively on it during an internship in the Portuguese Ministry of Foreign Affairs, from where I am still able of getting updated information regarding developments on the field. It was also on this environment that I got to learn the Portuguese Rapid Reaction Force is acting with great success in MINUSCA, which further increased my interest in the country.
There are however some clarifications regarding the scope of this research that ought to be clarified. While there are several perspectives one can use to look at the topic, it is not feasible to include them all in this thesis due to length limitations. As such, I will approach the topic of conflict-related sexual violence from 2014, when MINUSCA began operating in the country, to April 2020, as I was able to find recent information on the matter. Moreover, I will not be focusing on episodes of sexual violence perpetrated by peacekeepers, nor will I address male victims. There are two reasons behind this. On the one hand, the goal of this research is to
10 Internal displacement also increased, which further targeted women and girls who were raped within a CRSV
19 understand what are the challenges of a peacekeeping operation and non-governmental organizations whose reason to be on the ground, in the first place, is to tackle sexual violence that arose with the conflict, before their arrival. On the other hand, there is still a lack of research on male victims of sexual violence episodes – both because there is even a higher stigma for them to come forward when comparing to female victims, but also because (being a cause and a consequence of fewer research) the majority of international decisions on the subject usually cover sexual violence episodes against women and children alone.
Furthermore, an analysis of the Dr. Denis Mukwege Foundation is included in this thesis. Although the Mukwege Foundation’s hospital (Panzi Hospital), is located in the Democratic Republic of Congo (DRC), I find it relevant to study not only because of the geographical proximity of the phenomenon at hands – conflict-related sexual violence –, but also because its holistic approach is the most complete I have come across. Additionally, Panzi Hospital has developed a partnership with an hospital in Bangui.
3.3. Research design and data collection
The research’s data will be gathered through a triangulation of multiple sources, namely academic articles on CRSV and the conflict in the CAR, policy documents, reports from the media, MINUSCA and NGOs. The research is thus feasible since all sources are publicly accessible, being found on academic databases (Leiden University’s library, B-on, J-Stor, etc.) and on the UN and NGO’s websites. Overall, I plan to analyse both academic publications and documents from the UN and NGOs to gather what these reckon as their “best practices”. This analysis will then be compared with reports and statements of actions on the ground to monitor the actual effectiveness of those practices, if they are operationalized or not, and what obstacles are identified that temper with them.
In the initial proposal of this research, a set of interviews with NGOs that work with CRSV were also planned. The organisations are placed in The Hague, such as the Dr. Denis Mukwege Foundation or REDRESS, which would ease contact. With the interviews being semi-structured, the interviewees would have freedom to elaborate their answers and explain what they found more important and relevant in their daily work, which may vary from formal observations or the expectations of people who work on CRSV in an office, far from the
20 ground. In other words, they would serve the purpose of a deeper analysis of such challenges, as well as other factors that may not be clearly identified on paper but that are still relevant to workers.
This process would allow me to gather knowledge on the process victims go through when seeking help and what obstacles are felt as restraining for an efficient operation. Keeping in mind the sensitivity of the topic, a comparison between primary sources (the interviews) with secondary ones would take place, analysing and discussing whether the expected enforced mechanisms are effective or not, enabling building an analytical framework on the organizational effectiveness in tackling CRSV and its consequences. However, the current Covid-19 pandemic turned this impossible. Because these organizations had to adjust their work to the challenges the new coronavirus brought – both in their “normal” workload but also in preparing their infrastructure to receive possible Covid-19 patients, like the Mukwege Foundation in the DRC – it was impossible for them to spare time to answer the questions I posed.
3.4. Data analysis and measurement
The analysis of theoretical and academic considerations on CRSV enables the identification of issues when fighting it and possible contributions to improve it. Secondly, an analysis of the policies and actions the UN and its agencies ought to enact and apply through MINUSCA (their “best practices”), such as trainings, will be developed. Certain abstract concepts will also gain shape: MINUSCA’s “presence in a community” e.g. may be operationalized and measure by actions such as increasing the number of peacekeepers on a certain region, strengthening security. Equally relevant is the understanding of NGOs’ plans to assist and support of CRSV victims, in an occasional joint action with the UN (e.g. done by the International Rescue Committee). Connected to this “mapping” of the organizations’ desired projects, I will proceed to the operationalization of the information gathered thus far, analysing reports and online media publications.
Specifically, it becomes possible to establish whether a holistic model is followed or not by checking whether mechanisms included in the approach (such as legal assistance and socio-economic programmes) are provided to CRSV victims. Within training, it can be observable if
21 sessions and workshops include CRSV-specifics. It also becomes possible to study the evolution of awareness activities by seeing how frequent and spread across the territory they are, and their effectiveness through whether changes on the number of people seeking medical assistance, for instance, were registered after they were implemented. Political will, on its side, can be observable through political declarations relating to the conflict in the country, for instance, which may vary throughout time. The funding allocated is also tightly connected to political will – the higher the former is, the more it means the situation is regarded as serious by the organizations. Finally, one can analyze the attention given to Human Rights, Justice and Accountability by seeing changes in the support given to the Special Criminal Court, namely through the input given to its security concerns – regarding both the court’s premises but also the judges, lawyers, witnesses and victims’. This is also closely linked to the overall political commitment.
I would also approach organisations working on CRSV through the interviews, which would allow me to understand and establish whether what is formally planned is effectively enforced through real action. The interviews, particularly, would allow the understanding of the reality outside the paper and formal meetings, focusing rather on setbacks felt by those closer to the situation. Considering the legal and formal procedures they ought to follow when providing assistance to CRSV, interviewees would be asked to speak about practical obstacles that may make them unable to work with the planned efficiency and effectiveness. Nevertheless, even without the latter, it remains possible to identify if the best practices identified earlier are being (successfully) executed.
3.5. Limitations and generalization
The main limitation acknowledged by scholars regarding CRSV studies’ validity is the absence of empirical data, leading to an analysis through the existing literature on the topic and, to a certain extent, individual theoretical thoughts. This lack of data is both the consequence and cause of the fact the “hidden” number being considerably bigger than the data available, as there is solely data on women who stepped forward about their situation and were able to go to a hospital on a healthcare facility (Koos, 2017; Fanande, 2010). One cannot forget how victims might not want to participate in such studies, do not want to denounce their situation or simply cannot do so in the first place. Additionally, as a single case study research, it is impossible to
22 statistically generalise to other situations – which could provide limited validity (although I consider it solidly illustrates the idea I plan to test). Moreover, whilst a dynamic situation, its reliability might be tempered with if, using the same methods, CRSV in the CAR’s reality is studied again in a few years, as reality on the ground might have evolved and changed. Nonetheless, this research has a theoretical interest and so an analytical generalization is possible, providing a good starting point to test theory and the effectiveness of the good practices studied. By building an analytical framework of how to analyze the effectiveness of organizations on the ground – where their action really matters – it becomes possible to replicate that guidance to similar situations. Like so, I consider this specific case study relevant for the overall phenomenon of CRSV due to how it is theoretically built11.
11 The interviews here would also work as a deterrent to the lack of empirical data, as they consist on pragmatic
23
Chapter IV
The following section will focus on the current armed conflict taking place in the Central African Republic. Particularly, it will expand on its causes and on the several factions involved, as well as their relationship with sexual violence as weapon to damage “the other side”. In the end, I briefly focus on the number of organizations on the ground and illustrate the importance of a bigger action by the United Nations and non-governmental organizations.
4. Case Description
The Central African Republic has been under armed conflict on-and-off for the last decades. Having gained its independence in 1960, such frequent conflicts have brought obvious consequences to its development. The country’s Human Development Index is 0.381, ranking 188 out of 189 countries worldwide (UN Development Programme, 2018). It is estimated 79.4% of the population lives in poverty, while 70% also do not have access to safe drinking water (UN Development Programme, 2018; OCHA, 2019a). This situation was aggravated as the two main factions of the conflict causing instability, the Christian anti-balaka militia and the Muslim Séléka rebel coalition, have left nearly 2/3 of civilians dependent on humanitarian aid (UN News, 2019). The Séléka, headed by Michel Djotodia, was established in 2008. Being mostly Muslim and anti-government militias acting together, in December 2012 the Séléka began “targeting Christians populations and Bozizé’s supporters”, then President of the CAR (Welz, 2014). Bozizé was eventually overthrown in 2013 and Djotodia declared himself President.
Disregarding their formal dismantle, smaller ex-Séléka groups persisted fighting the anti-Balaka, a movement composed “mostly [by] young men whose families had been killed in the Séléka’s brutal campaign” – who, eventually, also split (Welz, 2014:603). At this stage, the UN and France started warning about the danger of a possible genocide in the CAR, due to an underestimation and failure in grasping how Séléka “was a very loose coalition over which Djotodia did not have effective control” (Welz, 2014:603). Equally relevant to understand is that while the Séléka have an apparatus of fighters, the anti-Balaka is categorized as a
24 “‘xenophobic movement’ with ‘multiple centres’” (Welz, 2014:603), having lost momentum after January 2014 as they achieved their main goal: expelling Muslims12.
The observable diversity of non-State actors operating in the CAR considerably complicates the attribution of CRSV crimes to its different perpetrators. Currently, 6 main ones are distinguished: a) Lord’s Resistance Army; b) Ex-Séléka factions13; c) Front démocratique du peuple centrafricain; d) Révolution et justice; e) Retour, réclamation et rehabilitation, and f) Anti-balaka associated militia (Report of the UNSG, 2019). The conflict has led to 75% of the population losing their livelihood – since farming is the population’s main income source, a stable residence is needed (Report of the UNSG, 2019). In 2018, confrontations in the South-East of the country between anti-Balaka and the Union pour la Paix en Centrafique, an ex-Séléka faction, led to mass displacement.
Internal displacement becomes thus extremely relevant for the situation as the majority of women and girls who were raped within a CRSV context “were intercepted on their way to farms or while fleeing to safety” (Report of the UNSG, 2019:12)14. Assistance and access to justice “have been virtually nonexistent”, as seen by Human Rights Watch’s (HRW) interviews on survivors of rape and sexual slavery (Margolis, 2019). Reports of how “women were raped by multiple fighters while held for weeks in makeshift camps or forced to watch as armed men murdered their husbands or children before raping [them]” are also frequent (Margolis, 2019)15.
12 In Yaloké, a town “where up to 30,000 Muslims lived prior to the conflict, Human Rights Watch counted fewer
than 500 Muslims in February 2014” (Welz, 2014:604).
13 Which can in turn be separated into the Union pour la paix en Centrafrique, Mouvement patriotique pour la Centrafrique, Front populaire pour la renaissance de la Centrafrique and the Rassemblement patriotique pour le renouveau de la Centrafrique (Report of the UNSG, 2019).
14 Although CRSV has females as primary victims, its extent against men and boys “is equally worrying” (Ngari,
2018).
15 The New Humanitarian (2014) also mentions “grandmothers are raped in front of their grandchildren and
children in front of their parents” and reinforce that “many of the women have been raped by multiple offenders and some on more than one occasion”.
25 HRW uncovered a “widespread and systematic use of rape” as war tactic, mainly through gang-rapes – nearly 70% the occurrences (Report of the UNSG, 2019:12). MINUSCA’s conflict-related sexual violence section has identified, in November 2018, anti-Balaka and armed Fulani affiliated with the ex-Séléka as the main perpetrators of CRSV16, documenting in March 2019 179 incidents of CRSV, including rape, forced marriages and sexual slavery – also underlying how CRSV “is largely underreported” (MINUSA, 2018; Office of the Special Representative of the Secretary-General on Sexual Violence in Conflict, n.d.)17. Both HRW and OHCHR have noticed how sexual violence is used as revenge if the victim supports “the other side”, with people being therefore targeted due to their religious affiliation, confirming CRSV is aimed at specific people18.
Nevertheless, as said, the real number is thought to be significantly higher, as rapes and other forms of sexual violence are often undisclosed due to stigma and fear of abandonment, not receiving any treatment (Margolis, 2019)19. Additionally, health clinics themselves are frequently not equipped to deal with the problem – in Bangui, “less than one third of clinics and health centres in internally displaced sites have the means” to assist CRSV victims (The
16 The Fulani are “a nomadic people that roam Central and West Africa; they are known for spending their days
searching for pastures to feed their cows” (Furcoi & Essa, 2017).
17 In 2014, the Special Representative of the UNSG on Sexual Violence in Conflict arrived in Bangui to enforce
her mandate “to provide coherent and strategic leadership to address sexual violence in armed conflict; engage in advocacy efforts with governments, including military and judicial representatives, all parties to armed conflict and civil society; and strengthen existing UN coordination mechanisms, and promote cooperation and coordination of efforts among all relevant stakeholders, primarily through UN Action against Sexual Violence in Conflict” (BINUCA, 2014).
18 Nalia, 38, “said that more than 20 anti-balaka came to her house in Bangui in February 2014 while she was
having breakfast with her husband and five children. Nalia said she heard the fighters say, “We came because of the Muslims. The anti-balaka took her and her 14-year-old son, saying, “Since you are a little Muslim, we are going to bring you with your mother.” When her son resisted, she recalled, the anti-balaka shot him in the back. The fighters took Nadia to a nearby house, where four of them raped her” (Human Rights Watch, 2017b). She was later tested positive for HIV.
26 New Humanitarian, 2014). Even so, in its first year of functioning, one clinic alone helped more than 600 victims – “of those, two-thirds had been raped, a majority by multiple offenders” (The New Humanitarian, 2014). The youngest was five years old.
In 2014, some clinics were treating around 10 to 25 women each day who have been subject to sexual abuse (The New Humanitarian, 2014). Nonetheless, one has to keep in mind the issue rose as the conflict continued in time. Moreover, although such numbers show the dimension of the problem, it is also a sign of how victims want to be seen by a medical professional, for many a first time20. Once in the clinic, they get through physical and medical examinations and, when possible, counselling is offered, although resources are limited. In 2014, Bangui was only able to offer sensibilization activities and “receive direct GBV response services” in 19 out of its 44 centres for the internally displaced (The New Humanitarian, 2014). In sum, “life-saving medical services, critical psychosocial support services and economic empowerment programmes to protect against sexual exploitation, are often insufficient or non-existent” (The New Humanitarian, 2014). Everything mentioned above led several organizations such as Mercy Corps, Médecins sans Frontiers, the IRC, UNFPA and UNICEF, to provide “a comprehensive health care package of medical, legal and psychosocial services” (OCHA, 2015). Despite the creation of a system to enable “listening to the survivor and documenting the complaint”, in 2015 complaints were rarely brought to justice (OCHA, 2015)21.
Currently, 139 partners operate in the CAR – specifically, 11 UN agencies, 55 international NGOs, 3 members of the international Red Cross movement, 68 national NGOs, 1 governmental institution and 1 regional organization (OCHA, 2019b). Although the lack of resources is beyond questioning, solving failures in the cooperation between organizations could improve the quality and quantity of services provided to CRSV victims. In December 2013, shortly before MINUSCA began operating, the international NGOs and UN agencies
20 “For many this is the first time they even see a doctor. They simply have not been given the possibility before
[and] many showed up spontaneously before we had even advertised. That shows just how sought-after these kind of services are” (The New Humanitarian, 2014).
21 The CAR’s systemic issues and lack of infrastructure and personnel (who often fled due to the conflict) have
27 that were already in Bangui faced several disagreements. While the former “claimed they needed more support from the UN in needs assessment, security analysis and funds”, the latter said there was a “lack of implementing partners” (Picco, 2014:4).
Since the start of the crisis in 2012, 6 peace deals have been made. The last one, signed in February 2019, “represents the greatest effort by both international and national actors to include all relevant parties to date” (Human Rights Watch, 2020). It was indeed recognized “the unprecedented investment of the international community (…) to support the recovery of the country” (UNSC, 2019:2). Having been agreed between the government, under President Touadéra, and 14 armed groups22, its main objective was promoting dialogue. The Parties committed themselves to eliminate the “deep-rooted sources of the current crisis and promote genuine national reconciliation”, solving the issues that led to the erosion of the social fabric and “encouraged separatism” (UNSC, 2019:2). On this regard, they recognize “the political manipulation of ethnic and religious identities poses serious threats to social cohesion and national unity, and that the current status quo is unsustainable” (UNSC, 2019:3).
Accordingly, the government is set to create the necessary conditions to ensure safety for Internally Displaced People to return home, in close cooperation with humanitarian actors and “in accordance with the international instruments in force” (UNSC, 2019:5). The government pledged to strengthen the country’s Rule of Law, together with initiating a national campaign of reconciliation and social cohesion (UNSC, 2019)23. On the other hand, the armed groups
22 Specifically, the anti-balaka (Mokom and Ngaïssona branches) and the ex-Séléka’s Front Démocratique du Peuple Centrafricain (FDPC); Mouvement des Libérateurs Centrafricains pour la Justice (MLCJ); Front Populaire pour la Renaissance de la Centrafrique (FPRC); Mouvement Patriotique pour la Centrafrique (MPC); Rassemblement Patriotique pour le Renouveau de la Centrafrique (RPRC); Révolution et Justice (Belanga
branch); Séléka Renovée; Retour, Réclamation et rehabilitation (3R); Révolution et Justice-Sayo (RJ-Sayo branch); Union des Forces Républicaines (UFR); Union des Forces Républicaines-Fondamentales (UFR-F) and
Union pour la Paix en Centrafrique (UPC).
23 More specifically, it plans “to accelerate the process to establish the Commission on truth, Justice, Reparation
and Reconciliation through the timely launch of national consultations and the adoption of a law on that Commission; to work with international partners and relevant associations for the establishment of a victim
28 agreed on refraining from attacking “hospitals, schools and places of worship, and sites for internally displaced persons” together with refraining from “violations committed against civilians, including sexual and gender-based violence, in particular against women and girls” (UNSC, 2019:7)24.
Moreover, the guarantee of enforcing and maintaining adherence to humanitarian principles, protecting national and international non-governmental organizations’ bases and staff, ceasing aggressions towards humanitarian convoys – as well as “the extortion of funds from humanitarian workers” was also agreed on. Further, humanitarian assistance would have “unconditional and secure access [to vulnerable communities], wherever they may be and regardless of their ethnicity or religion” (UNSC, 2019:8). The parties also agreed on establishing a Commission on Truth, Justice, Reparation and Reconciliation “with the aim of promoting truth, justice, reparation, national reconciliation and forgiveness”, for which they can seek support from MINUSCA (UNSC, 2019:8).
It was also agreed that “States and international organizations that constituted the Facilitation Panel of the African Initiative for Peace and Reconciliation in the Central African Republic” will support the agreement’s implementation by providing “political, security, technical and financial support [and] to conduct advocacy (…) to mobiliz[e] the political, security, financial and technical support necessary” (UNSC, 2019:10)25. They were also asked to establish a
support and redress programmes; and to develop and implement an action plan on traditional reconciliation mechanisms, in close consultation with traditional chiefs” (UNSC, 2019:6).
24 “Sexual and Gender-Based Violence (SGBV) is any harmful act of sexual, physical, psychological, mental, and
emotional abuse that is perpetrated against a person’s will and that is based on socially ascribed (i.e. gender) differences between males and females” (OCHA, 2019c).
25 Specifically, the Cameroons, Angola, Congo, Sudan, Equatorial Guinea, the Republic of Congo, Gabon, Chad
and the UN. Such advocacy may consist on approaching “politicians, religious leaders, civil society, the media and traditional authorities, as well as neighbouring States, international partners meeting in the International Support Group on the Central African Republic, and regional and international organizations, to seek collective and unanimous support for the achievement of the objectives of this Agreement” (UNSC, 2019:10).
29 mechanism “to monitor and evaluate progress in the implementation” of the agreement (UNSC, 2019:10)26.
Finally, a new government was formed to include several members of the armed groups, who were “appointed to senior positions, including rebel leaders against whom there is credible evidence of responsibility for atrocities in recent years” (Human Rights Watch, 2020). Despite everything just mention, throughout 2019 armed groups still committed “serious human rights abuses against civilians”, controlling more than 70% of the CAR’s territory (Human Rights Watch, 2020). In addition, two rebels leaders ended up resigning from their positions in the government in August and September of 2019.
26 Among other, by evaluating and verifying the monitorization of the implementation of the commitments,
guidance and decisions, and “holding regular consultations with representatives of the signatory armed groups” (UNSC, 2019:11).
30
Chapter V
5. Empirical Findings
In chapter II (Literature), the main aspects identified as requiring a deeper clarification were the need for a survivor-centred focus with an holistic approach through an improved training, awareness-raising, political will, funding, and cooperation between actors. Like so, this section will develop on specific UN and NGOs’ policies and actions to tackle CRSV in the Central African Republic, separating their actions through the aspects mentioned above. Afterwards, findings on Human Rights, Justice and accountability will also be displayed. These informations, gathered while researching on the best practices and problems just mentioned, also play a vital role in an effective fight against CRSV – even though they are not as clearly identified in the actors’ “best practices” as the others are. This individual analysis of each of these topics enables the identification of what problems and challenges are brought to the surface in each one of them. For a matter of organization, inter-agency and inter-organizational collaboration will be displayed throughout the chapter, instead of having a specific sub-section, as the other topics. Moreover, when addressing the organizations “best practices”, I will proceed to separate the different organizations from each other, whereas in the problems identified (political will and funding) I will not, as their opinions are often similar and merged together.
5.1. Holistic approach
United Nations
Addressing the multi-sectorial framework, MINUSCA has been allocating resources and coordinating an “effective response and assistance to sexual exploitation and abuse victims”, encompassing physical and medical care, psychosocial assistance, and shelter, in collaboration with its implementing partners (MINUSCA, 2017a). Despite this, the extreme violence that continues ranging the country does not ease the weight on poor social structures that (for now) are capable of supporting CRSV survivors.
To identify the biggest challenges and to “represent and defend the interests of sexual exploitation and abuse victims to ensure they receive the required care and protection”, MINUSCA hired a Field Victims’ Rights Advocate (FVRA) in 2017, following the UNSG’s
31 directive (MINUSCA, 2017a). In the same year, FVRA’s from the CAR, DRC, Haiti and South Sudan met to discuss achievements and challenges faced until then27. The importance of addressing “victims’ immediate and longer-term needs” was highly underlined, together with the need of “providing livelihood and educational opportunities to the most vulnerable [which] could prevent them from becoming victims” (MINUSCA, 2019e).
In 2019, another meeting took place, counting with the participation of human rights officers, staff from MINUSCA’s Office of the Deputy Special Representative of the Secretary-General/Resident Coordinator/Humanitarian Coordinator for the CAR and the Office of the Special Coordinator on Preventing SEA, among a few others (MINUSCA, 2019e). Here, challenges were identified in regard to “maintaining contact with all victims, especially in insecure environments”, as well as difficulties registered in ensuring that “the in-country approach towards preventing and responding to sexual exploitation and abuse is joined up and strongly coordinated” (MINUSCA, 2019e). It was also discussed however an “information-sharing protocol” that is currently being implement “across the country team, [being a] step forward in balancing the principle of confidentiality with the need to exchange information in a timely manner for the benefit of victims” (United Nations Victim’s Rights Advocate, 2019). Additionally, there was a follow-up on a pilot program that maps “victims’ rights approaches and services available to provide legal, medical, psycho-social, safety, shelter and livelihood support for victims” (MINUSCA, 2019e). The VRA considered it to give guiding information, “including gaps in support and be a key enabler to improve the quality and timeliness of assistance to victims” (MINUSCA, 2019e). The CAR’s FVRA also discussed with officials from the National Commission on Human Rights and Fundamental Liberties “its role in realizing accountability for victims” (MINUSCA, 2019e).
On its side, OCHA works towards a holistic management by collaborating with other actors and supporting “the establishment and functioning of prefectural and sub-prefectural
27 The UNSG’s report “Special Measures from Sexual Exploitation and Abuse: a new approach” which “called
for the rights of victims to be placed at the heart of the UN’s action” on SEA was also discussed (MINUSCA, 2019e).
32 committees to combat GBV and harmful practices” (OCHA, 2019b:45). It assists its clusters with technical matters, acting to implement Inter-Agency Standing Committee (IASC) guidelines on GBV28. Within its 2019 Emergency Response Plan, its Health cluster plans to work on “surgical, trauma and rehabilitation injuries”, hand in hand with a focus on “the mental health response for survivors and clinical management of rape cases” (OCHA, 2019b:48)29. Among a few others, the cluster plans to “ensure medical and psychological care for rape survivors”, to distribute hygienic delivery kits to pregnant women and midwives and ensure the “management of obstetric and neonatal emergencies [and] syndromic management of STIs [Sexually Transmitted Infection]” (OCHA, 2019b:48).
International Committee of the Red Cross
The International Committee of the Red Cross (ICRC), on its hand, is present in the Kaga-Bandoro hospital (in the central part of the country), inter alia other locations, where it “practices internal medicine and performs minor surgery” (Maguire, 2014)30. It tries to work along the “chain of care (…) from first aid training to supporting tertiary hospital services” (Maguire, 2014:24). Notwithstanding, it also provides clinical services to CRSV survivors, offering psychological care through a team that includes a trained psychologist. Health centres equipped as such “allow a more permanent service, and [despite the] huge stigma associated
28 The IASC was created in 1991 and is the longest-standing and highest-level humanitarian coordination forum of
the UN system. It brings together 18 UN and non-UN organizations, ensuring the “coherence of preparedness and response efforts, formulate policy, and agree on priorities for strengthened humanitarian action” (IASC, n.d.).
29 OCHA’s Response Plan is enacted by several clusters, namely: Camp Coordination and Camp
Management/Non-Food Items/Shelter; Water, Hygiene and Sanitation, Education, Logistic, Livelihoods and community stabilization, Nutrition, Protection, Health, Food security, Emergency telecommunications, Coordination and Refugee Response Plan. Some of these clusters may have sub-clusters of their own.
30 “War-wounded are referred to Bangui hospital and flown there by an ICRC plane, though many patients are
fearful of crossing Muslim–Christian lines and refuse to make the trip. Patched up, they often prefer to travel onwards, accompanied in relative safety by their own ethnic group” (Maguire, 2014:24).
33 with sexual violence, these services will hopefully be more widely used as women and girls come in from the bush to seek assistance” (Maguire, 2014:25)31.
Médecins sans Frontiéres
MSF’s support also includes psychological consultations – in addition to pregnancy and STDs tests and medical operations. By providing the former, patients are greeted “with a safe space to share their experiences and to discuss their feelings of sorrow, humiliation and fear” (Médecins sans Frontiéres, 2014). Signs of depression are checked during consultations, which usually last a few months.
International Rescue Committee
Similarly to the UN and the ICRC, also the IRC’s emergency response “prioritises the provision of services to meet the health, psychological and safety needs of GBV survivors” – particularly through counselling, emergency case management and referrals to health services in better equipped locations such as Bangui, Kaga-Bandoro and Bocaranga (Mora et al., 2014:27)32. IRC reports that 90% of survivors supported by the organization were “immediately referred for health care”, underlining nonetheless that health services are often “out of reach to survivors” (Mora et al., 2014:26) – in 2015, only 1/3 of all health facilities in the country offered “post-rape exposure treatment consisting of emergency contraception or psychosocial support for rape survivors” (OCHA, 2015). This is often because while “government-run, private and some NGO-run health clinics” do not provide free care (which is “a significant deterrent to survivors”), NGOs that do offer their services free of charge are frequently not
31 Several testimonies show CRSV victims who are abducted and taken to live with the rebels who are hidden in
the countries’ bushes, or they themselves flee to hide there once their villages, homes and/or themselves are attacked.
32 “While fixed centres were established in displacement sites in Bangui, IRC has sought greater coverage in more
