More or less ongoing since 1996, the DRC is experiencing a prolonged conflict. It has been characterized by extreme violence, mass population displacements, widespread rape, and a collapse of public health services [6
]. The total death toll (1998–2007) was estimated at 5.4 million [8
]. The conflict keeps flaring up despite several attempted peace accords and the deployment of a UN peacekeeping force, MONUC (Mission des Nations Unies au Congo
), the largest UN peacekeeping operation with a strength of 18,000 uniformed personnel.
Sexual violence has not been sufficiently addressed by the DRC government, despite recent efforts such as the establishment of the Ministry of Social Affairs and the Family
and initiation of a concerted initiative on sexual violence composed of NGOs, the United Nations and the Congolese Government. Sexual violence has further been included in the mandate of DRC's Truth and Reconciliation Commission. In July 2006 the Congolese Parliament passed the Law on the Suppression of Sexual Violence
which anticipates strengthened penalties for perpetrators and more effective criminal procedures. Also, the DRC is party to several human rights treaties addressing women's rights, such as the Convention for the Elimination of All Forms of Discrimination against Women [9
] and the Rome Statute of the International Criminal Court [10
] which recognize sexual violence as both a crime against humanity and a war crime. However, DRC's juridical institutions remain weak and impunity for perpetrators largely prevails.
Humanitarian programming in the field of sexual violence is difficult. Not only is meeting the multiple needs of rape survivors a complex undertaking, the perpetual lack of data hampers programme evaluation and further research. There is great scarcity of data on the prevalence, circumstances, characteristics of perpetrators, and physical or mental health impacts. Several reasons contribute to this scarcity. Humanitarian programmes tend to allocate all available, usually scarce resources to directly address survivors' needs and pay less attention to data collection and research (see [11
]). Furthermore, conflict situations impede structured research due to prevailing chaos and security threats for staff. Existing data are usually derived from project proposals and reports to donor agencies. Data thus collected may not be coherent and may not be easily compiled. Insufficient cooperation between humanitarian organisations may contribute to disintegration of data [12
]. Data collection is further impeded by poor reporting of events. The majority of rape survivors resists speaking out for fear of social stigmatisation or denial ([13
]). And if survivors do report sexual violence, it is often months or years after the incident, making a timely representation of sexual violence impossible. The UNHCR estimates that less than 10% of sexual violence cases in non-refugee situations are reported [17
Care for rape survivors is complex, since it, ideally, comprises health care, psycho-social care, safety and legal aid so as to enable the survivors to institute proceedings against the perpetrators ([18
Timely access to health care is essential as sexual violence constitutes serious health threats for survivors. Sexually transmitted infections (STI's) are recognized consequences of rape [20
], which need to be treated at an early stage [21
]. The effectiveness of post-exposure prophylaxis (PEP) regarding possible HIV-transmission also depends on early initiation of therapy. As to inhibit unintended pregnancy, emergency contraceptive pills have proven to be effective in 56 – 94% of cases when taken within 120 hours of unprotected intercourse according to the World Health Organization [22
]. Tetanus and hepatitis B vaccination should also be administered within 14 days of the incident unless the survivor was fully vaccinated [23
Psychological support is regarded as another important aspect of rape care, as psychological effects of sexual violence are manifold and potentially last for a lifetime. About half of female rape survivors develop clinical symptoms of Post-Traumatic Stress Disorder (PTSD) at some point in their lives [24
]. Other psychological manifestations include anorexia/bulimia nervosa, depression, and anxiety ([25
]). During conflict, the psychological distress of rape survivors can be greatly aggravated by the breakdown of usual support systems and by the absence of a safe and supportive environment for healing [27
]. Psychological care aims at stabilizing the survivor emotionally and mediating social relationships. Considering the common cultural background, local women seem best for providing psychological support and mediation between family members. Awareness-raising among the public is another pillar of programme design and focuses on eliminating prejudices and lowering discrimination against rape survivors. Simultaneously, strategies are promoted that aim at educating women on how to avoid risky situations, for example fulfilling chores in a group of females rather than alone, about available rape care and the importance of seeking medical care as soon as possible.