Women, men and children are being abducted for months at a time by armed militias and made to work as sex slaves and forced labourers in the gold and diamond mining region of the Okapi forest, eastern Democratic Republic of Congo (DRC), in a terror campaign that shows no signs of stopping.
Killings, tortures and rape
Thousands of people have fled their villages in the forest, in Ituri region, Orientale province, to escape the constant threat of abduction and violence. Seeking safety in numbers, most are staying with friends or relatives in small towns such as Nia Nia, whose population had at times almost doubled since the start of the year.
People are arriving in Nia Nia with stories of the atrocities they have suffered or witnessed at the hands of various militia groups, including killings, torture and repeated rape. A Médecins Sans Frontières (MSF) medical team has been working in the town since May to provide them with primary healthcare, emergency medical care and much-needed psychological support.
Violent sexual assaults
"They describe what they have lived through as hell," says MSF psychologist Ana Maria Tijerino. "I have trouble believing that such a level of horror is possible. Victims have been held as sex slaves - sometimes for months at a time - and sexually assaulted violently by several men, several times a day, often in front of their parents, husbands or relatives."
Between May and early July, MSF medical staff in Nia Nia provided 3,586 medical consultations. They also treated and provided psychological support and counselling to 143 women, three men, and two children who had survived sexual violence, and to more than 36 survivors of other types of violence, including torture, sexual humiliation and being forced to witness atrocities carried out against relatives.
MSF is working closely with local women's groups in Nia Nia which provide psychological support to rape survivors.
Stepping up medical activities
The violence in the region reached a peak in April and May, but with attacks continuing, and survivors still fleeing to Nia Nia and other areas, MSF is stepping up and widening the scope of its medical activities. In a single week in June, MSF's mobile team treated 20 women in the village of Bafwanduo who had been raped.
People who live in the forest and work in the mines, extracting gold and diamonds, have been the main target of the latest attacks. Violence linked to the region's mining trade, however, is not new.
"Various armed militias prey on the miners, demanding a portion of the profits," says Kevin Coppock, MSF's head of mission in Orientale province, "and there are reports of extreme violence against those who cannot or do not hand over profits. After a militia leader was killed by the military in April, the level of violence, and the brutality, increased significantly, targeting both the mining communities and people in the surrounding villages."
For MSF's team, providing survivors of sexual violence with emergency medical care is complicated by the fact that many have been raped multiple times over a long period, so when they arrive at MSF's clinic in Nia Nia, it is often too late to protect them against HIV, sexually transmitted infections or pregnancy. This protection, known as 'post-exposure prophylaxis', is most effective within 72 hours of an assault. "Women who have been held as sex slaves for months are being deprived of such essential care," says Ana Maria Tijerino.
Physical and psychological trauma
The after-effects of suffering such violence can be debilitating. "Months after an assault, the physical and psychological trauma is still apparent in the survivors," says Ana Maria Tijerino. "Many suffer from pain, infected wounds, stress, depression and nightmares."
The ongoing insecurity makes it harder for survivors to recover. "No one knows what tomorrow will bring," says Ana Maria Tijerino. "People live in fear of having to return to the mines under the yoke of their attackers, which adds to their stress. They are afraid because they know they cannot survive economically without working in the mines. Nia Nia is a poor town with no opportunities for earning a living. The victims are scared for the future and haunted by what they have lived through." The situation remains fluid. Every other week people flee the violence anew and arrive in Nia Nia, while others have left the town again. In order to maintain their bare living they return to work in the mines.
"Violence and sexual violence are nothing new in DRC," says Ana Maria Tijerino, "but for the victims, these atrocities are not normal. No one should have to accept violence on this level."