In Times of War, Treating Rape Survivors' Devastating Wounds

April 10, 2007

By Margaret Aguirre
Translation by Johnny Kambi Mabelengo

Bukavu, DRC—Dr. Denis Mukwege had already been a physician in his native Democratic Republic of Congo for 15 years when he began to notice a frightening trend.

More and more women seeking medical help at his hospital had been raped so brutally that they were suffering fistulas—a severe and painful gynecological rupture that causes women to leak urine and feces. Left untreated, they can develop into infections, resulting in infertility and even death. And the shame of the condition often causes women to be cast out of their communities.

“In 1999 alone we received more women who had been violated this way than in all my 15 years of working as a gynecologist in the region,” Dr. Mukwege recalls. “We had the impression that it was a new phenomenon. It was astonishing for me. We had to ask the question of whether we could continue to stay quiet.”

Staying quiet was never Dr. Mukwege’s style.

Following his studies in gynecology and obstetrics in France, he returned to DRC, where he practiced medicine at the Hospital of Lemura in South Kivu Province. There he installed gynecological and obstetric services for rural women as well as a training program for staff.

But early in Congo’s decade-long civil war, the hospital was destroyed. So Dr. Mukwege moved on to Bukavu, also in South Kivu, where he continued to practice medicine in difficult conditions and serve the health needs of the rural poor.

He began to realize that women in Bukavu lacked proper medical assistance during childbirth. So he spearheaded the effort to build a maternity ward and an operating room at the local Panzi Hospital that is supported by International Medical Corps. He subsequently recognized the need for treating and caring for victims of increasing incidences of sexual violence—including providing surgical care, psychological assistance and services to empower them economically.

Then, the cases of rape and consequent fistulas began to skyrocket.

“It is the character of the violence carried out on the woman, not trying to kill her but destroying a piece of her, that was so shocking. During wars, we see rape—but one doesn’t see such mutilation of a woman’s vagina, introducing bayonets or pieces of wood. …This wasn’t the normal type of sexual violence.”

Often, the victims are unimaginably young—as young as two. The added tragedy of this violence is that the victims are shamed into silence and fearful of seeking treatment. “When women come for care, they are generally fearful that afterward they will be cast out,” Dr. Mukwege explains.

Still, he is encouraged that slowly he is beginning to see changes.

“It is enormous that these women are getting the courage to be able to speak out, to be able to say what has happened. But today we still have the difficulty of being able to identify how many women are needing and waiting (for treatment). Who knows about those who wait and cannot speak and are left to die slowly.”

Thanks to Dr. Mukwege’s innovations, the Panzi Hospital has cared for more than 13,000 victims of sexual- and gender-based violence. Of those, 4,000 were cases of fistula repair. The hospital also has provided psychosocial assistance to about 11,000 patients, and provided economic empowerment and micro-finance training for nearly 3,000 patients as they completed their treatment and were reintegrated back into their communities.

Dr. Mukwege trains fellow obstetricians, nurses and other medical staff in courses organized and supported by International Medical Corps. After years of experience in treating women with fistula, he has taught colleagues in DRC and around the world how to surgically treat this complicated condition and provide follow-up care.

But because he recognizes that patients often suffer in silence and rarely voice their experiences, he has become a voice for them, traveling around the world­—often at his own expense—to tell their stories and raise awareness about the use of rape as a weapon of war.

“I think what strikes me most profoundly is that we are becoming more and more of a unified group, and I think that this group is going to absolutely reach the eradication of this disease that is sexual violence.”


For 30 years, International Medical Corps has worked to relieve the suffering of those impacted by war, natural disaster and disease by delivering vital health care services that focus on training, helping devastated populations return to self-reliance.