A Congolese community-based health program for survivors of sexual violence

Conflict affects civilian populations “physically, psychologically, economically, and socially” [1]. The Eastern Democratic Republic of Congo (DRC) has been the site of two wars involving multiple African nations and armed conflict between rebels and soldiers for the past 16 years. Several reports document the number and severity of cases of violence perpetrated against civilians, especially with a focus on sexual violence [2,3]. Although insecurity and fear related to reporting cases limits surveillance of sexual violence [4], in Eastern DRC two surveys estimated the prevalence of sexual violence against women (16-40%) and men (24%) using population-based approaches [5,6]. Between 2004 and 2008 at Panzi Hospital, a referral hospital in South Kivu province, girls between 3.5 years to women 80 years of age accessed services for sexual violence [7]. Several reports describe the brutality accompanying sexual violence including mutilation and penetration with objects [7,8]. A review of medical records from two rural NGOs and Panzi Hospital revealed that 59% of patients accessing services for sexual violence in 2006 were gang-raped [3]. Physically, the consequences of sexual violence include traumatic fistula and risk of infections including STI/HIV [7,8]. If injured during the sexual assault, survivors are more likely to experience post-traumatic stress disorder related symptoms [9]. Other mental health concerns include depression and difficulty participating in daily activities [3,10].As demonstrated by the high infant mortality rate (114/1000) and maternal mortality ratio (1,100/100,000), poor health outcomes continue to be an important issue throughout the DRC [1]. The 2011 UNDP Human Development Report ranked the DRC last amongst 187 countries in a composite measure of human development [11]. While the health system was deficient before the conflict [12], violence, destruction, limited resources and displacement has further limited the ability of the health system t