One Remote Village, 4 Days, 250 Rapes

I remember the sick feeling in my stomach as I read the email from our medical coordinator in the Democratic Republic of Congo:

“We are facing a massive case of community rape in Walikale Health Zone. …We expect that in total the number is about 250 women raped in 4 days – a major catastrophe.”

I stared at the screen in bewilderment.

I had been to the DRC a number of times, met many, many women and children who had been raped and whom we were treating. Indeed, the phrase, “Rape as a weapon of war” has become a tragic cliché to describe what has been happening in the eastern part of the country the last several years.

But how do you wrap your brain around such numbers – the scale of the onslaught, the systematic, diabolical nature of an attack in which women, girls, boys are raped by multiple armed men at once, often in front of husbands and children.

The attacks by hundreds of soldiers began July 30 in the village of Luvungi, located near mines rich in gold, cassiterite, and coltan. When our teams were able to reach the village days later and began treating the survivors, they first thought there might be 24, then 56. As more and more victims came forward and the scale of the catastrophe became evident, word spread quickly and the wider international community took notice. Secretary of State Hillary Clinton condemned the attack. U.N. Secretary-General Ban Ki-Moon dispatched a special representative to investigate.

As a humanitarian organization that has been operating in DRC since 1999, our focus is healing wounds and helping people to recover and rebuild their lives: providing medical treatment to a woman who has been raped, psychological assistance, and livelihoods assistance so she can get back on her feet and care for herself and her family.

But our mission also focuses on prevention and education - raising awareness about issues like sexual and gender-based violence, whether it is in a remote community in eastern DRC, or here in Los Angeles, where International Medical Corps is based.

During her visit to our programs in DRC last year, Hilary Clinton declared, “We believe there should be no impunity for the sexual and gender-based violence committed by so many.” The U.N. recently echoed her sentiments.

International Medical Corps stands with them in sounding a call to action for eastern DRC. We are very fortunate to have a powerful ally in educating the wider public about what is happening there. This month, the Geffen Playhouse is staging a production of the astounding Pulitzer Prize-winning play, “Ruined” about the triumph of the human spirit in DRC. International Medical Corps serves as an educational sponsor for the production, and all proceeds from the September 28th show, underwritten by The Edgerton Foundation, will go to International Medical Corps’ humanitarian work. Following the performance, Nancy A. Aossey, our President and CEO will join the cast on stage for a conversation with the audience about the play, our work in DRC, and the struggles of its people.

For tickets, go to: http://www.internationalmedicalcorps.org/ruined

It is hard for me to imagine the epidemic of rape in eastern DRC getting worse, and yet is has. All of us must do more to help bring an end to the violence there. How many mass rapes have to occur before the world says enough?

Sienna's Final Post from Dem. Rep. of Congo

Final post from actress Sienna Miller, who's been visiting International Medical Corps programs in DRC:

=====

It has been a whirlwind three days and so much has happened that I don’t even know where to begin. Twenty four hours of the last seventy two have been spent in a car so we’re all feeling weary. I’m not sure if I even have the energy to attempt eloquence but I’ll give it a shot.

We left Bukavu for Chambucha on Wednesday morning at six. The journey was everything we had been warned about and more: muddy roads that could swallow a truck, flat tires, makeshift bridges, military checkpoints, very young men with very large weapons. It was a six-hour drive through Kahuzi Biega National Park and north to Chambucha. The scenery was breathtaking. Thick dense jungle, bamboo trees and wild orchids, monkeys, every shade of green you could possibly imagine. Enormous spider webs and their equally enormous creators, such a change from the urban feel of Bukavu. There were children swimming in the river that borders the forest where the FDLR (Rwandan rebel group) are in hiding, and where the FARDC (Congolese government troops) have taken positions along the road, weapons trained at their sides. And that’s what’s so confusing about this place..utter purity and beauty juxtaposed with brutal violence.

So where we are heading is an area engulfed by guerilla activity. As a result tens of thousands of people have had to flee their homes in neighboring villages and have been essentially herded into Chambucha. The road we are on stops there, and we are received like heroes. The people had been told beforehand of our arrival and hundreds turned up to clap and cheer and sing us into our camp. It was so moving and there is no way I can do it justice in words...David Serota has it all on film, so it will no doubt eventually speak for itself.

International Medical Corps’ hospital facility is set up next to the compound where we are staying and after dropping our bags we walk fifty meters into the fenced area for a tour. The care being provided, considering the extremely remote location, is again incredible. The stories I hear are again, harrowing. I met a mother who was running away from a group of militia three days earlier with her baby strapped to her back. They both got shot, but survived and thankfully made it into the facility in time. Her boy is so little and the huge bandages on his arms break my heart.

Everything about this place breaks my heart. These people all have stories which they share with me and there is just simply too much to try to grasp. Everyone has lost something, everyone has lost someone. I meet malnourished babies, mothers, fathers, widows and widowers, malaria sufferers, their eyes glazed, victims of rape and pillaging. They are all here in massive numbers, and their stories are agonizing.

I meet a group of about a hundred who have selected an old man to read out on behalf of them all, their list of grievances. They have no homes and no possessions and they need others to recognize they are in crisis.

I sat down with the Mai Mai, an armed community defense group that has been placed here by the government, but not paid for months. The general told me that he wants to go back to his old post but leaving this area would look like he was plotting to join another force and would essentially place a target on his head. He was surrounded by his men in green uniforms, holding their ammunition and AK 47s. It is intimidating for me to interview them and certainly against the norm for them to answer difficult questions posed by a woman. Even though their definition implies that they are allies of the government, I know that there is really no “good” armed group in this country.

I later asked a victim of rape if she felt protected by the Mai Mai or any of the military here. She simply said “I don’t trust any man wearing a uniform”. This woman had been raped on three separate occasions, each time requiring fistula repair. The last time she was held captive for three months and was consistently raped by eleven men. The reason she had had so many of these encounters was because she was disabled and therefore when the men came into the village and the women fled, she was always left behind. She simply could not run as fast as the others.

I sit with a fourteen year old girl who was raped nine days ago… and another and another. It is impossible to fathom the sheer number of women who have been violated here, and their stories are way beyond anything I can even begin to comprehend.

I was able to deliver one wonderful treat in Chambucha. Lysa Heslov and her terrific foundation, Children Mending Hearts, provided hundreds of t-shirts for the children who are in desperate need of clothes and it was uplifting and rewarding to later see them running around smiling in their new clothes.

We spend the night in bunk beds within the camps and eat a supper of cassava leaves with some river fish and rice. There is no electricity so everything is cooked on clay pots over coal and we wash before dinner with a bucket of cold water. I haven’t felt so present in a long time. There is something to be said for eliminating choice and the calm that comes with it. It dawns on me that I get so overwhelmed at home and life is often spent planning or organizing or making decisions in general. Here there is really not much choice at all and as a result I find myself stopping and actually having the time to process the experiences we have had.

The drive back on Thursday took about seven hours. We slept in Bukavu and then drove eight and a half hours to Rwanda.

I broke down twice on this trip. The first time after being in the displacement camp outside Goma, seeing the woman with the colostomy bag. I had to step into an empty tent and sob. I had consciously planned on keeping it together, but the visual and the look in her eyes broke me. After that, some form of defense mechanism kicks in. Of course you feel enormous empathy but there is no room for personal emotion in these places. Still, as we crossed the border into Rwanda, it all hit me, and I cried. It was a pretty silent journey to Kigali because we all leave a piece of our hearts in DRC. There is a lot to process, but I have never gone on such an incredible journey before and am inspired to come home and start the real work.

Please go to imcworldwide.org and if you have anything to spare, donate. Trust me the money you spend will be very well used and these people need and deserve all the help they can get.

Day 2 of Sienna's Diary from Dem. Republic of Congo

More reflections from actress Sienna Miller, who's in DRC visiting International Medical Corps' programs:

Day 2
I guess it’s important to clarify why I’m here. International Medical Corps is an incredible organization that is providing healthcare and support to people in dire need. I met with them in Los Angeles two months ago and they approached me to see if and how I could help in anyway. They desperately need funding and general awareness raised both for the organization, and for all the projects they are involved with. If my involvement in any way could contribute to either then I was more than happy to be involved. My one request was that if we were going to start working together, it was imperative, that I see and experience what is going on first hand… So here I am.

Read Sienna's entire blog here: http://www.takepart.com/blog/2009/04/27/sienna-millers-travelogue-from-dr-congo-day-2/

In Congo with Actress Sienna MIller

These are reflections from actress Sienna Miller, who is visiting International Medical Corps programs in the Democratic Republic of Congo all this week. Quite an incredible woman...

======
Day 1

We boarded the flight to Rwanda having spent a night in a gorgeous old colonial hotel in Nairobi. Felt such anticipation as we flew over Lake Victoria and watched the landscape beneath us with its deep reds transforming into luscious green and mountainous peaks. Rwanda is so full of history and so far from home. A country that has been ravaged by war and yet once landing we were met by a sea of smiling faces and stunning landscape. The only reminder of genocide on our four-hour drive to the border of Congo was the banners stretching across the road as a memorial to those who were so brutally murdered.

Read Sienna's entire blog here: http://www.takepart.com/blog/2009/04/27/sienna-miller%E2%80%99s-travelogue-from-dr-congo-day-1/

The More Things Change...

It is strange for me to return to the Democratic Republic of Congo after just a couple months away and witness what has changed and what remains the same.

Over more than a decade in DRC, an estimated 5.4 million people have died as a result of ongoing conflict and disease, and millions of others were forced to flee their homes. It is often dubbed the deadliest war in modern history. While much of the country stabilized following a peace accord and subsequent elections in 2006, hostilities among government forces and the numerous rebel groups in the eastern sliver of DRC have persisted. The situation worsened in late ’07, causing almost a million people to be newly displaced.

In recent months, violence in the most volatile areas in the north, like Masisi and Rutshuru, has eased slightly. But the displaced are still streaming southward into the camps outside Goma. These seven camps where International Medical Corps is operating are bursting at the seams.

The last time I was here was in January. As we drove down Sake road, about eight miles outside Goma, I had noticed a few dozen bright yellow tents dotting an open field, about a mile from three of the largest displacement camps, called Mugunga I, II and III. Today, those tents number about 500, which translates to around 2,000 people. It’s become a small, ``splinter” village, suddenly transforming the landscape.

One thing that does remain the same here is the spectacular, verdant land, filled with banana trees and tall grassy fields stretching toward Lake Kivu. But another is the suffering of the people who live on this land – people who have escaped unimaginable violence and arrived in crowded camps with few belongings and fewer options.

Yesterday we escorted a large group of U.S. congressmen and embassy officials into Mugunga I camp to see what’s happening there, the care IMC is providing, and how they might be able to help. They were shocked by what they saw and heard.

Inside Mugunga I, home to 28,600, life is brutally, consistently tough. Conditions are cramped and unsanitary, the daily rains turn the black lava rock that covers the ground from nearby Nyiragongo volcano into a thick mud. Clean, safe water and nutritious food are scarce. The camp president tells us that 70 percent of the women are widowed because of the conflict. Rape and sexual violence remain rampant in and around Mugunga. Because women and young girls are generally responsible for collecting food, water and firewood, they become targets when they travel outside the camp to do so.

And we continue to treat children who are severely malnourished. One six-month-old patient I saw this week weighed about three pounds, her jaw sunken and her skin melting off her teeny bones.

Still, In the face of all this tragedy, there is something else, something lovely, that remains the same at Mugunga I: people working, playing and trying to live their lives as best they can with dignity and a sense for the future. As I walk through the camp the scene is as it was last time and the time before that: young men getting their hair cut at the barbershop in the sprawling market; a checkers game with bottle caps as pieces; the booming sounds of the local ``cinema,’’ where a video plays to a packed tent of people; women singing as they peel vegetables; the four elderly tailors who hold court in the market, perched at their Singer sewing machines, sharing stories; children shouting and laughing as they play marbles or soccer or jump rope. These scenes have remained the same on every one of my visits. This is daily life for the residents of Mugunga I camp – their home for who knows how long.

In Congo, A Life Reclaimed

I’ve been thinking about the notion of having to start over in life. After some personal tragedy, or a dramatic fork in the road, you find yourself searching for a new path, new meaning, a new method of survival.

Today I met a woman named Esperanza. She is a nurse with International Medical Corps at a displacement camp called Bulengo, outside the town of Goma in the eastern part of the Democratic Republic of Congo. Throughout the morning, Esperanza showed me around the IMC clinic that delivers primary health care and nutrition services to a population of about 27,000, advising me on how many patients she was treating and what sorts of maladies they were experiencing.

At one point I gathered a group outside the clinic to find out how they came to Bulengo. I asked how many of them had lost a loved one in the violence that has plagued this northern axe of DRC. Esperanza called out, “mon mari” – my husband. Only then did I learn that Esperanza doesn’t just work in Bulengo Camp; she also lives there. In fact, she began working for IMC after receiving care from IMC.

Four years ago, Esperanza was living north of here - in an area called Massisi that has been decimated by fighting between rebel and government forces - when her husband was killed. In late 2007, as the conflict intensified, she and her three very young children fled to Bulengo. Six months later, she was working again as a nurse.

Esperanza tells me she is grateful for the chance to use her skills, and proud to be serving her own neighbors.

Her journey – in terms of geography and profession - took me just a few paragraphs to describe, but to her it has no doubt been a painful, circuitous and lengthy one, filled with fear and doubt.

Esperanza found herself dumped upside down into the rushing water, yet succeeded in finding her way to the top again. She managed not just to survive but to keep her children safe and find a new way to care for them.

With one million people displaced in and around Goma due to the latest violence, she is one of so many who are starting over, trying to write new and better chapters to their lives.

Ben Affleck Visits IMC Program in Congo

Hi all,

Ben Affleck and a crew from Nightline recently visited one of International Medical Corps' primary health care and nutrition centers near Goma in eastern Congo (see my accompanying photo gallery).

He interviewed our phenomenal program coordinator, Woseh Gobeh , as well as some of our beneficiaries at the center.

Affleck is hoping to raise awareness about the ongoing conflict in DRC and its impact on civilians. His video diary of his journey through DRC aired June 26 on Nightline.
Here's a link to a portion of that show:

http://youtube.com/watch?v=PTkWTb2-Jyc

Hidden Epidemic in Democratic Republic of Congo

Hi, all.

It’s been a year since I was last here in eastern Democratic Republic of Congo. Anyone who’s heard me talk about DRC knows how much I love this place, the intensity of the landscape and the people, their generosity and strength.

They certainly need that strength.

The sad truth is that violent conflict is still raging, particularly in the North Kivu Province, where government forces (called the FARDC) and the various rebel groups (like the predominantly Rwandan FDLR, CNDP forces, and the Mai-Mai) are constantly going at each other. Civilians, as always, are caught in the middle.

Over the summer, the conflict intensified in North Kivu, forcing hundreds of thousands from their homes. And despite a ceasefire reached in January, the region remains chronically unstable. Since late 2006, an estimated 850,000 have been displaced in this province alone, and that number is expected to increase in the coming months as the FARDC attempts to retake areas held by the FDLR.

Much has been said and written about the epidemic of sexual violence perpetrated against women and children. Frankly, no amount of words is enough. But there is another epidemic here that has not captured the spotlight: during the 1998-2003 war, and the resulting humanitarian catastrophe, most of the estimated 5.4 million deaths have come from hunger and disease. The most vulnerable are the children.

That’s where an 18-month-old boy named Ivote (pronounced EE-vote), comes in. He was named in honor of DRC’s historic elections in late 2006. He very nearly didn’t make it to his first birthday.

Last October, Ivote’s parents and his three brothers fled from their village near Masisi, where some of the worst fighting has taken place. Already, two of his siblings had been killed.

For months, Ivote had been suffering from diarrhea and malnutrition. No doctor or traditional healer was able to help him. By the time he and his family had made the 40-mile journey south to Mugunga displacement camp, outside Goma, he was near death – a skeletal child who could not stand, could scarcely speak, and his limbs frozen stiff. At the age of 11 months, he weighed just over two pounds.

His mother, Sophia, tells me she had lost all hope that he would live.

International Medical Corps is running primary health care clinics and supplementary feeding centers in Mugunga and other nearby camps, serving more than 300,000 people. IMC immediately transferred Ivote to Virunga Hospital in Goma, where we treat about 100 new cases of severely malnourished children a month.

Ivote suffered from a type of severe malnutrition called marasmus. Most of us are familiar with what this looks like from the images that emerge during famine: shockingly skeletal children, who are weak and cry unconsolably. Children with marasmus are literally starving and can’t possibly be fulfilled by any amount of food; they finish and want more and more. But if they’re allowed to eat all they want, they can overdose and vomit from the excess food in their stomachs. So the amount of food they eat has to be calculated carefully and meted out in three-hour intervals.

Marasmus is actually relatively uncommon in North Kivu. Ninety percent of children here suffer from what’s called kwashiorkor (kwash for short). With kwash, the baby is bloated, with fat feet and cracked skin. In the most severe cases, the skin bursts and the child is covered in large swaths of bloody sores. Babies look like burn victims. It is wrenching. The difference with kwash is the children don’t want to eat; it’s difficult for them to eat. Here in North Kivu, families often must flee fighting and hide in the bush. They go many days without food or with only protein-deficient food like cassava that causes children’s bodies to bloat with water. By the time they reach the camps, they have stopped eating entirely.

The vast majority of the children we’re treating at Virunga Hospital have come from the camps, where they are identified by IMC for more intensive treatment. When they arrive, they often suffer from other complications, like diarrhea, anemia and respiratory infection, which must be treated immediately so that they can better recover from the malnutrition.

The children and moms – often the siblings as well, who can’t be left alone in the camps – move into the center, where they are clothed and fed a diverse diet, including maize flour, beans, oil and salt.

IMC’s recovery rate at Virunga Hospital is 95 percent. For most children, recovery time – if they suffer from no other maladies – takes around five weeks, after which they are discharged back to the camps and are monitored at IMC’s supplemental feeding centers.

For Ivote, recovery took two months. Today, his chubby cheeks and bright eyes make him unrecognizable as the same child in the photos when he arrived. He toddles around the hospital grounds like a typical 18-month-old. Upon recovery, he weighed 14 pounds.

As I’m leaving the center, the IMC van arrives with a new batch of severely malnourished children. A father, seeing me taking pictures, hoists his feeble daughter up to his shoulder and asks me to take hers. Her legs are covered in cracked, bloated skin. Her right eye is sealed shut from conjunctivitis. It is heartbreaking to look at her – and her father’s anguish at her condition.

The only consolation I can find is that in all likelihood, in a month’s time, she, like the scores of other children here, will be fully recovered and headed back to her home in the camp. That is my hope.

**Note: The photos of Ivote and some of the other severely malnourished children are graphic and difficult to look at. Many of you might not wish to see them pop up in my blog gallery so I chose not to include them. But I’m happy to email them to any of you who are interested.

Coming Home

Hi, all.

I’m on my way home. Not there yet but after 130 hours in cars, 30 hours on planes, and 10 hours on boats over the last five weeks, this hotel room in Kigali , Rwanda feels like a wonderful first step to my final destination.

Throughout this trip, it’s been hard not to apply what I’ve seen to my own personal life.
I’ve been missing home, missing family and friends, and all the thousands of familiarities and creature comforts that go with home.

So last Wednesday, as I stood on a dock in the town of Baraka, in eastern Democratic Republic of Congo, and watched hundreds of Congolese refugees returning to their homeland for the first time in many, many years, I fought back tears.

For one family I met, it has been seven long and painful years since they fled from their small village in remote South Kivu province into western Tanzania . Muzalio Chiba, his wife, Suzanne, and their two-year-old daughter, Anna, escaped, along with a wave of their neighbors, just as the country’s civil war began to sweep into their village of Tulonge .

For seven years, in the refugee camp where they lived in Tanzania , they tried to make some sort of life for themselves. And for seven years, they dreamed of returning to their homeland and their family.

On Wednesday, for the first time since 2000, Muzalio and Suzanne, along with their now four children, set foot once again on Congolese soil.

They are among the tens of thousands of Congolese who are finally making their way back home, after the official end of DRC’s decade-long civil war. Many of these returnees have been away as long as 10 years.

It wasn’t until about a year ago that it became safe again for them to come home. Since then, large ships, each carrying up to 600 Congolese, dock each week at the ports of Baraka and Uvira, near the northern tip of Lake Tanganyika .

On this particular day, I watched as IMC’s medical and logistics staff helped each of the returnees gingerly make their way down the steep gangplank onto the dock; babies, the elderly and the sick were physically carried or transported by stretcher.

There, I saw Muzalio and Suzanne, like the 300 or so other people on the ship, holding all that they possessed in the world: a bit of food, a makeshift cloth sack, filled with their clothes and other personal belongings, and their identification papers. Their entire lives were boiled down to this. I remember the looks on their faces – at turns joy, anticipation, and consternation. What would happen to them now?

Many Congolese have no other family left in the country – or if they do, they may be hundreds of miles away from the port. What will they do for food, medical care, a place to live, a job?

In July of 2006, as thousands began repatriating, IMC identified massive shortfalls in the care and services they were receiving. The 55 existing health centers in two of the health zones were unable to offer adequate medical support for the huge influx; shelter had been provided for fewer than 2,000 of an estimated 60,000 returnees; nearly 3,500 women had experienced some type of gender-based violence over the prior nine months, with virtually no follow-up care; there was extremely limited access to sanitation facilities or clean water (in one area, the only water available to a population of 37,000 was five miles away); and there were virtually no modes for people to earn an income and support their families.

So in January of ’07, with funding from the U.N. refugee agency, UNHCR, IMC began providing health care to returnees at every step of the process - from the boat to their villages of origin. This includes primary health care and follow-up care, screenings and referrals for those suffering from malnutrition, pre- and post-natal care, immunizations, as well as treatment and counseling for victims of sexual violence and assistance in reintegrating into society. In addition, IMC has begun improving access to safe water supplies and sanitation by rehabilitating existing water sources, constructing new ones, installing rainwater catchment systems, and building latrines.

In all, IMC is serving about 560,000 people, including those repatriated from Tanzania , those displaced within Congo because of the war, and a host population that already was underserved.

At the transit center, where returnees stay on average 48 hours, they are registered, receive medical examinations, are fed hot meals and are able to take showers, and given a three-month food ration. They then are driven in convoys – with IMC medical escorts on board - to their villages of origin.

Sitting outside the registration tent at the transit center in Baraka, Muzalio and Suzanne told me they’re thrilled to be back in their country, but uncertain about what lies ahead. They feel lucky to be healthy and to have family back in their village (about 200 miles away), whom they hope to see soon. Still, their needs will be enormous on this long journey home, as they try to pick up the pieces and rebuild their lives. I feel like we’re going far toward helping them do that. For those who have no support system at all and are most vulnerable I feel we’re giving them what they need as well.

My mind fixes on the image of IMC staff at the port in Baraka, holding these refugees’ hands, helping them grab onto the rails as they put one foot in front of the other, make their way down that slippery ramp, and finally reach firm ground.

That’s the goal; that’s the mission.

Wounds of War in Congo

Hello again, this time from the town of Bukavu, on the far eastern side of the Democratic Republic of Congo, near the border with Rwanda.

It is staggeringly beautiful here - tropical forests, vibrant flowers and sparkling lakes. But this landscape is scarily deceptive.

The past week I’ve spent a lot of time listening to women and young girls - listening to stories, horrific stories, trying to fathom what they’ve experienced, and thinking about how we help them get what they need to rebuild their lives.

DRC is seething with the after-effects of a decade-long civil war - widely viewed as Africa ’s worst modern conflict - which claimed the lives of nearly four million people and displaced two million others.

In 2003, the country formed a transitional government, and just a few months ago, held its first democratic elections in 46 years. That was a big step, no doubt about it. But the outside world has generally viewed the elections as a much-awaited reason to turn away and move onto the long list of other pressing geopolitical concerns.

The fact is, in many ways the war here never ended. Violence is pervasive, and for the people of northern and eastern DRC in particular, elections and peace accords are largely window dressing. This area is overrun by rebel groups and militias who are terrorizing villagers and fighting for control of the country’s vast reserves of diamonds, gold and other resources.

If anything, the humanitarian crisis here is mounting. DRC’s health infrastructure has been destroyed, with more than a third of the population lacking access to even the most basic health care. What’s more, there is little electricity and few roads outside major cities. According to the Human Development Index, DRC, a country the size of Western Europe , ranks 167th out of 177 countries.

International Medical Corps began working in DRC’s most volatile region of North and South Kivu Province in 1999 and is the only international relief agency that has maintained a permanent presence here. We're supporting 59 health facilities and 19 nutrition centers, serving an overall population of about 330,000.

One of the biggest challenges is access; most routes consist of unpaved dirt roads covered in mud and boulders, and rife with enormous potholes. Navigating these roads at around 10 miles an hour means it takes a full day to reach any given village. We – and when I say “we”, I mean IMC’s Country Director, Birame Sarr , and his phenomenal staff - spent a good two hours a day digging ourselves and other trucks out of the mud, or trying to get our tires back on the planks of a hastily constructed bridge.

Security, obviously, is the other big problem. IMC’s local staff are in regular contact with the warring factions, who seem to appreciate the care we’re providing and have allowed us to continue without much incident. But things are unpredictable, to say the least.

To get a painfully vivid snapshot of what’s happening here, you need look no further than the women and young girls – girls as young as two. The Kivu provinces have produced some of the highest numbers of sexual violence victims in the world. You can literally see the trauma on their faces, and in their medical charts.

Their stories are appalling, and there is a sinister, sickening uniformity to the details of these stories, i.e. who the perpetrators are and the acts they’re committing.

Take one young woman named Bingi whom I met at a health facility IMC supports in the remote village of Chambucha . She told me she’s 17, although our staff members think she may actually be 15. This angelic-faced girl shyly described for me the night four months earlier when uniformed men with guns broke into her home. They beat her husband, took her to the woods, and raped her repeatedly over several days. She was eight months pregnant at the time. A month later, she delivered her child still-born.

Subsequent to the attack she has suffered a condition that has become a pernicious marker of the violence and absence of adequate pre- and post-natal health care in DRC: a severe gynecologic injury called fistula. Thousands upon thousands of Congolese women suffer from its devastating physical and emotional effects. There’s no polite way to describe fistula, a vaginal rupture that causes urine and feces to seep down the woman’s legs and that causes her to smell. As painful as it is and difficult to treat, women with fistulas doubly suffer from the stigma associated with it. They are often referred to with the pejorative “baqua,” Swahili for “rape”. They are frequently ostracized by their families and communities and many are forced to leave their homes. Even those who remain find it near impossible to perform the already back-breaking daily tasks of carrying 50- to 100-pound loads of water, food and supplies to their homes.

Bingi was comparatively fortunate: her husband has not cast her out, and she did not have to travel far for treatment. In fact, she is one of the first women to undergo fistula repair surgery at Chambucha, through an IMC-supported program that provides medical personnel and training on this complicated procedure, and then careful monitoring and follow-up. That was a huge step forward.

But most women in this sprawling region are forced to get themselves to Bukavu and a highly sophisticated facility called Panzi Hospital - the only one in the region with the ongoing surgical capacity to treat a condition as complex as fistula. The hospital is run by a heroic surgeon, Dr. Denis Mukwege, who recognized early that fistula cases in his homeland were skyrocketing, single-handedly took on the problem by training doctors around DRC to treat it, and has performed thousands of surgeries himself – including the one for Bingi in Chambucha.

Outside Panzi Hospital, I met legions of women and young girls, some from as far away as Rwanda and Burundi , who had come seeking medical help. Hundreds of them sit on long benches in an open-air “warehouse” and wait. And wait. And wait.

While the first 72 hours after a woman has been raped are critical toward treatment and prevention of sexually transmitted infection as well as fistula, many rape survivors are held captive for days, weeks, months. And those who are able to escape soon after their attacks either cannot access treatment quickly, or are too ashamed to do so. Most of the women I met outside Panzi Hospital were just such cases.

Thirty-year-old Jeanine told me that for two weeks she was held captive about 30 miles away, in South Kivu’s Kahuzi-Biega National Park , where rebel armies frequently hide. She was repeatedly raped by the four uniformed men who kidnapped her. She has a large gash on her forehead and cuts all over her arms from the beatings. Jeanine’s three children were also kidnapped. One has been found and is living with her sister; the others, she has no idea where they are. Jeanine arrived at Panzi two days ago and is now awaiting the results of an HIV test; she also has begun to experience crushing pain in her lower abdomen that may signal fistula.

She is hoping to see a doctor soon. Through a translator I ask if it’s at all helpful for her to be here with other women who’ve suffered similarly and be able to talk about their ordeals. She says, “No, we don’t talk about it.” That encapsulates much of the problem: stigma is so entrenched and it’s difficult to educate communities – men and women - on ending sexual and gender-based violence.

So in addition to treating these women’s physical wounds, IMC is helping to provide counseling, community education programs, as well as income-generating activities to help them get back on their feet, whether they return to their homes or not.

It’s impossible not to be overwhelmed by the medical and psychological needs across this region. And yet without us, it would be so much worse; those most vulnerable to the violence and lack of health care would have almost nowhere to turn. So we keep building medical facilities one brick at a time; providing food to malnourished children one cc at a time; delivering clean water one liter at a time; and helping plant vegetable gardens, one seed at a time.

There is no other way.