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A line of
women wait their turn at the UNICEF clinic in Goma, DRC.
Credit: IRIN
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Armed conflicts led to the
deaths of some 2.8 million people in 2000, according to the British Medical
Journal on Conflict World Wide. While the majority of people who died as a
result of war were men aged between 15 and 44, a quarter were women aged 15
to 29. The International Rescue Committee, a humanitarian organization that
is very active in the area of gender-based violence (GBV), estimated that
women and children comprised 40 percent of the 350,000 deaths in the five
eastern provinces of the Democratic Republic of the Congo (DRC) between
August 1998 and April 2001.
These figures only begin to tell the story of the effect of armed conflict on
the female population of war-ravaged countries. While death and disability
are the direct result of war, the breakdown of public health systems has a
long-term impact on the population as a whole. Factoring in the impact of GBV
on the war-affected female population means adding a new level of war-related
health issues.
In a publication on GBV in the DRC titled I have no joy, no peace of
mind, Medecins sans Frontieres (MSF) describes the ordeal of a
34-year-old mother raped in a field and forced to watch her 15-year-old
daughter being attacked as well. " As she tried to escape, they beat her
up and broke her leg with a gunshot," the woman said. "Three men
raped her. I was so shocked. I so wished I could have prevented this from
happening. She was still a virgin."
Another rape victim in the eastern DRC town of Goma told IRIN how she and her eight-year-old daughter were
raped by "military men" in front of her husband. The husband later
rejected the woman, leaving her to cope by herself and deal alone with her
trauma. Sexual violence against women and girls in conflict situations leads
not only to terrible physical suffering, but mental health problems too.
"Families and communities can be affected over generations,"
Juliane Kippenberg, co-author of a 2002 Human Rights Watch report 'The War
within the War' on sexual violence against women and girls in eastern DRC,
told IRIN. "A lot of women [in eastern DRC] were raped in front of their
children. They will be affected," she said.
The effects of war on women's health and well-being
Physical effects: Many girls and women are gang-raped during or after
war. Some are very young, even infants, others are very old. As a result they
suffer multiple physical injuries. Sometimes the effects are felt
immediately, others take years to manifest. Among the injuries are abrasions
and tears:
Fistula - a
tear in the walls separating hollow internal organs such as the vagina and
the rectum. This causes very painful eliminations and incontinence, along
with strong odours.
Many of these women suffer family and community rejection.
Broken bones - as a result of torture and gang rapes. Many of these
are not treated properly because of a lack of access to public health. This
results in lifelong disability.
Amputations - used as a brutal reminder to victims of the enemy's
'intent' (used often during the civil war in Sierra Leone).
Back pain and migraines - sometimes immediate, but often long-term,
chronic effects of brutal attacks.
MSF described the physical injury of women suffering from GBV as often
"pain all over the body and in particular areas where they have been
beaten with fists, weapons or sticks. Many complain of joint pains to the hip
and back when their legs have been extensively and violently spread
out."
Stanilas Bya Munga of GTZ (Deutsche Gesellschafft fur technische
Zusammenarbeit), described to IRIN the torture of women by combatants in the
town of Bukavu, eastern DRC: "Sometimes, after raping a woman, they
would spread her legs until they snapped like chickens".
Malnutrition: Often, civil conflict and human rights abuses have
either paved the way for famines such as those in Biafra in the 1960s and the
Horn of Africa in the mid-1980s, or prevented food from reaching starving
communities as happened in Angola. Authors Elisabeth Rehn and Ellen Johnson
Sirleaf noted in a 2002 United Nations Development Fund for Women (UNIFEM)
publication titled War Women and Peace "women and children
die in extremely high rates in such circumstances". Even in Bosnia in
the early 1990s, the death rate was four times as high as during the pre-war
period in one Muslim enclave due to severe malnutrition. And because women
are usually the last to eat, when resources are scarce, they become severely
anaemic. They lack iron, which can be fatal for pregnant women. A study among
Somali refugees showed that up to 70 percent of the women of reproductive age
were anaemic. And in Afghanistan, 9.8 percent of people suffering from scurvy
(lack of vitamin C) were women of child-bearing age.
Reproductive health: During conflicts, women's reproductive health is
severely threatened. Breakdowns in public health services and the scarcity of
money mean little or no access to birth control, life-saving
pregnancy-related care, and supplies for menstruating women. It is only
recently that humanitarian agencies have included sanitary supplies in relief
packages. Without them girls stay home from school and women miss work and
training. This is especially important in post-conflict, refugee camp
settings.
In poor countries, the mortality rate during pregnancy and delivery is 40
times higher than in the industrialised nations, according to a 1995 UN
study. During and after armed conflict, countries' statistics become even
more dramatic. In the DRC approximately 42,000 women died in childbirth in
2001. One woman in 50 dies giving birth in Angola. In Afghanistan policies
restricting women's movement were catastrophic for their health: maternal
deaths were among the highest in the world.
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Women
suffering from fistula wash their clothes together.
Credit: IRIN
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Conflict also has indirect
consequences on women's health. In Eritrea, the recent border war with
Ethiopia caused a redeployment of scarce resources to the frontlines. This
meant that women did not get the care they needed and led to many
'spontaneous' abortions (miscarriages) brought on by physical and mental
stress. After miscarriages women need immediate medical assistance to save
their lives and prevent infertility.
Unwanted and unplanned pregnancies can also be a result of war and GBV. Women
displaced from their families are especially vulnerable. Those using family
planning to avoid pregnancy need it even more when displaced. However, in
refugee camps these services are often not available. A strategy of forced
pregnancy has been used in recent and ongoing conflicts such as those in
Bosnia/Herzegovina, East Timor, Kosovo, Rwanda and Sudan. Tens of thousand of
women and girls have suffered the trauma of being raped repeatedly and
impregnated by their violators. Bosnian women for instance faced terrible
choices, according to Rhen and Johnson Sirleaf. Some chose abortion if they
were able to get to services early enough. Others had the babies, but abandoned
them without ever seeing them. The few who kept their babies faced rejection
by their families and social isolation.
Young girls who have lost family guidance due to war and displacement are
especially vulnerable to sexual exploitation. WHO in Liberia estimated that
up to 80 percent of displaced girls had had induced abortions by the age of
15. Such early pregnancy is very risky for girls because their bodies have
not developed enough to deliver safely nor are they mature enough to be
parents. Girls aged 10 to 14 are five times more likely to die in pregnancy
and childbirth than women aged 20 to 24.
Sexually Transmitted Infections (STIs): STIs are reaching epidemic
proportions globally. Although many of these diseases are easily diagnosed
and treated with antibiotics, this aspect is often neglected in emergency
situations. A study of Rwandan women attending antenatal clinics in refugee
camps in Tanzania found that more than 50 percent were infected with some
form of STI. Military populations are two to five times more likely to be
infected than civilians, so during conflict - and with GBV - the rates in the
female population rise. HIV is one of the most serious STIs resulting from
rape.
Mental health: The mental effects of war and GBV can be enormous.
Anxiety, post- traumatic stress disorders, depression and suicide are the
most common. One Muslim survivor from the eastern Bosnian town of Srebrenica
made this statement to UNIFEM : "Many people have acquired PhDs studying
us, but no one helps us". The woman had lost her husband and sons,
watched children die of hunger and was repeatedly raped. Now she had nothing.
The burden of caring for others: Despite all the horrors women
experience during and after wars, they are also the ones who bear the burden
of caring for the ill. They try to protect and care for children and the
elderly and provide support for parents and husbands. Rarely is there anyone
to care for them. Often husbands who do survive and stay with their families
become so depressed that they drink too much and abuse their families. Many
women spend their time and energy trying to keep the peace in their
households and lining up for hours to get food, or offer sex to strangers for
money in order to buy medicine.
Rhen and Johnson Sirleaf state emphatically at the end of their study that
"it is tragic that basic health care for women affected by war must
compete with food, shelter and landmine clearing".
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