Olga's voice trembles as she describes what happened: "Yesterday afternoon I left home to go and look for a bit of yucca in a field near the airport," she says. "On my way there, two men armed with machetes stopped me and told me to sit down. One covered my eyes and the other began to undress me."
Stories like this are common in Bangui, the capital of Central African Republic (CAR), where sexual assault is an epidemic. In 2018, Doctors Without Borders/Médecins Sans Frontières (MSF) teams cared for 4,000 survivors of sexual violence across the country. In our project at the Bangui Community Hospital alone, more than 800 people have been treated in the first half of this year.
In CAR, as in many other countries, sexual violence is a taboo subject. Victims of sexual assault are often forbidden from talking about it due to the shame it could bring on their family. Some of the local languages don't even have a specific word for rape.
"I thought about committing suicide several times," says Olga. "I felt ashamed when I walked down the street and I thought everyone was looking at me. I can't sleep at night." She's now being treated by an MSF psychologist at Bangui's Community Hospital, where we run a project for victims of sexual assault known as Tongolo, which means "star" in the Sango language.
Bringing care to patients
Though years of conflict and instability contribute to the high rates of sexual violence in CAR, many sexual assaults are committed between neighbors or within families, says Beatriz García, coordinator of the Tongolo project. "In most cases the problem is resolved amicably in the community or between families to avoid bringing shame upon the family--forgetting that this is a medical emergency that must be taken care of," she explains.
The project is open to the entire population but emphasizes treatment of children and men, because these cases are often less visible and tend to be more complex. "In CAR, there are many men who have suffered sexual assault but who are too scared to speak up," says García. "They are reluctant to ask for help. There is huge pressure in the community, with a very violent stigmatization."
In order to make treatment available to the community, MSF has expanded its project in the Community Hospital to the outskirts of Bangui, opening a new support service in the Bédé-Combattant district. "We are sure that this will allow survivors to arrive in a period of less than 72 hours, which is key for mitigating the possible consequences of the assault," explains García. Olga showed up at the new MSF service 24 hours after the assault, in time for prophylaxis against HIV and other sexually transmitted infections to be effective.
Spreading the word
The medical and psychological services offered by MSF are among the very few options for victims of sexual violence in Bangui. There is no legal or socioeconomic support to help victims overcome the consequences of their experiences. Unmet needs for sexual violence care remain huge.
However, thanks in part to awareness campaigns, people are beginning to realize the scale of the problem. Martine, 53, is a widow and mother of three children. When fighting broke out in 2013, she fled and took shelter in the forest, where she was attacked and raped by two armed men. Injured and terrified, she kept the pain of her experience inside for years.
"I hadn't told anyone what had happened to me, but then some people told me that I had no reason to feel afraid or ashamed," she says. Now receiving care at the MSF treatment center in Bédé-Combattant, she seems relaxed as she leaves her weekly consultation with a psychologist. "I feel relieved. I'd been carrying a weight on my shoulders for six years."
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