Bangui — The presence of armed groups and continued fighting causing displacement across the Central African Republic (CAR) has led to an escalation of insecurity leaving women and girls vulnerable to forced marriage and extreme violence, including rape.
Despite recent commitments from governments, UN agencies and NGOs to prioritize protecting women and girls from sexual and physical violence, current efforts in CAR remain underfunded. In the capital Bangui less than one third of clinics and health centres in internally displaced sites have the means to assist survivors of gender-based violence (GBV).
"There are almost no protection mechanisms in place and basic services such as medical assistance and counselling are limited in the spontaneous sites where displaced women and girls have gathered," said Elisabeth Roesch, emergency coordinator for women's protection and empowerment with NGO International Rescue Committee (IRC).
Since opening two women's centres in Bangui at the beginning of the year, the organization has helped more than 600 women recover from violence, the youngest being only five years old. Of those, two-thirds had been raped, a majority by multiple offenders.
"Grandmothers are raped in front of their grandchildren and children in front of their parents. Many of the women have been raped by multiple offenders and some on more than one occasion," said Dr Armel Yangba at the Padre Pio clinic on the outskirts of Bangui.
"There is one girl out there who is only seven years old. We think she was raped," he continued.
The waiting room outside Yangba's office is always full. Grandmothers, schoolgirls and mothers with their young daughters wait patiently for their turn. On an average day the clinic treats 10-25 women who have been subject to rape or sexual abuse.
"For many this is the first time they even see a doctor. They simply have not been given the possibility before," said Yangba. "Many showed up spontaneously before we had even advertised. That shows just have sought-after these kind of services are."
At the clinic the women get physical and medical examinations. They are tested for sexually transmitted diseases and pregnancy. The small medical centre also offers counselling for women who have been raped. But resources are limited.
"This is one of few health centres in Bangui assisting rape survivors. We struggle to treat all the women that come to the clinic," said Yangba.
Protection from violence, including GBV, has been established as a high priority for the humanitarian response. In Bangui only 19 out of 44 centres for the internally displaced receive direct GBV response services and offer sensitization. Targeted efforts, including life-saving medical services, critical psychosocial support services and economic empowerment programmes to protect against sexual exploitation, are often insufficient or non-existent.
Outside Bangui local and international NGOs and UN agencies, such as UNICEF, assist survivors of sexual violence in Bossangoa and Kaga-Bandoro. In many areas there is a total lack of services for women and girls who have suffered sexual abuse. The continued presence of armed groups, sometimes in the displacement sites, continues to pose a threat to women and girls.
With increasing food insecurity and malnutrition, rape and sexual violence is on the rise. The Anti-balaka, who originally came into existence as a reaction to the depredations of the Séléka are now metamorphozing into criminal gangs who are also becoming a threat to displaced populations.
"Rape and sexual violence is the number one fear among women and girls," said IRC's Roesh.
In January and February UNICEF partners reported 781 cases of rape and sexual assault, compared to November and December last year when 300 cases were reported.
Many GBV survivors are 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. Survivors face a lack of socio-economic support, continued trauma, serious health risks, and lifelong complications.
Seated on a wooden chair in a spot sparsely shaded by plastic sheeting in the internally displaced camp in Bangui, Nancy, a 21-year-old mother of three, tells how machete-carrying men broke down the door and forced their way into the house.
"They were armed and they threatened to kill us. We had no choice but to do as we were told," she said, adding: "They forced me to sleep with them, they raped me. They raped my mother and my sister too."
Over the six months she has been in the camp she has not seen a doctor or received any medical treatment. French medical organization Médecins Sans Frontières (MSF) which runs a hospital and a clinic in the camp said they had 10-15 female patients a week who are survivors of rape.
"Rape is very stigmatized in CAR. Many women do not dare to talk about being raped. They are afraid that their husbands will leave them, or that they will be segregated from society. That also means that they are less likely to seek medical care," said MSF coordinator Tessy Fautsch.
The presence of armed groups in the camp and the fact that many women and girls are forced to leave the camp to find food and firewood leaves them vulnerable to assaults.
Women and girls are also recruited into armed groups and militias where they are extremely vulnerable to sexual violence, forced marriage, to HIV/AIDS and the stigma of being in the armed group or militia. In January 2014, 23 children were released from armed groups, among them six girls.
"Girls only 15, 16 years old are left to support themselves, running the risk of becoming victims of exploitation," Roesch said.
She feared many cases of abuse were unreported simply because victims did not know the clinics existed.
"In the IDP camp we manage to reach people. Outside the camps, in many Muslim communities, for example, we don't have the same access," Roesch said.
Meanwhile, women who were victims of rape continue to face financial and medical problems, as well as threats and continued violence.
"Women are still very cautious, only leaving the camp during the day. Many fear being attacked while they collect wood or water or using toilets without a lock. They are testing the waters to see if it's possible for them go back," said Roesch.
[This report does not necessarily reflect the views of the United Nations.]