Spotlight interview with Dr Denis Mukwege (Panzi hospital, DRC)

"It is a tragedy too awful for words, and no one wants to deal with it"

Panzi hospital, in Bukavu, Eastern Congo, is specialised in treatment and surgical reconstruction for women victims of sexual violence. Over and above this humanitarian response, Dr Denis Mukwege nonetheless insists on the overriding need for a political solution to tackle the root of this violence, used as a weapon of war for over ten years, and calls on the leaders in the Great Lakes region to assume their responsibilities. He also points the finger at those profiting, in total impunity, from the state of "non-war/non-peace" in this region abounding in precious raw materials, and appeals to the international community to take genuine steps to control the source of raw materials within supply chains.
Disheartened at times by having to operate and re-operate on the same women suffering repeated mutilations, Dr Mukwege finds the strength to carry on in the courage and ability of these women to pick themselves up again.

Do you think that an event like the World March of Women, held in October in Bukavu, is capable of having a concrete impact on the fight against the sexual violence still being perpetrated on a massive scale in the region?

We are hoping that the World March of Women here in Bukavu will have an impact on the decision makers and will finally bring about a change for women. Until now, I have the sad impression that the leaders of this world do not want to deal with this problem, that there are huge financial interests at stake, pushing respect for human life far into the background. The government, for its part, tries to deny, to play down this violence against women. But for those of us living with the victims on a daily basis, it is a tragedy too awful for words.

The context of the region means that the international community, stricken with remorse over the tragic events in Rwanda, is closing its eyes and ears to this situation, which is the follow-on to the Rwandan war and genocide.

The first mistake was to let a whole army cross through the region, with soldiers, armoured vehicles, munitions and an entire treasury, and to let them settle here, with soldiers and civilians sharing the same camps. I used to go to these camps as a doctor and would see the military training that still used to go on there.
Then, after a year, the Rwandese president, Kagame, with the blessing of the international community, attacked the camps. Rwanda is not a rich country with major resources; it was allowed to attack the camps and carry out huge massacres. Some returned to Rwanda, others went deep into the forest. The luckier ones managed to cross the borders and flee. The less fortunate ones are dead. The others stayed and adapted to life in the forest. Meanwhile, between 1998 and 2001, the Rwandese army stayed in Congo, and rather than going after the FDLR, it started to do business here. Throughout this time, the civilian population, and especially the women, were trapped between two fires.

How did you become so well known for your condemnation of the sexual violence against women?

Following the destruction in 1996 of the Limere hospital that I was managing in the south, I reached Bukavu in 1999 as a refugee, like many others. I was horrified at the terrible state the women were in. I went to work at Bukavu’s general hospital and would see women dying en masse. Women haemorrhaging following a difficult home birth would arrive too late and die. I decided to offer them obstetrical care here in Panzi, south of the city, where women have no health care facilities. The first woman I operated on was a woman who had been raped and shot in her genital organs. She had a terrible infection. She is now able to walk without crutches. The same year, 45 women came, victims of the same atrocities, mass rapes followed by gunshot and bayonet wounds to the genital organs. One day, the ICRC brought a young girl aged 18 or 19 to me. She had been raped, the barrel of a gun had been placed in her vagina and shot. Her entire urogenital system was in shreds. I tried to put the pieces back together as best I could. It took six operations. I told myself I could not keep silent any longer. I contacted MSF (1), to ask them to help us speak out about this tragic situation. There was the case of a young woman who had been raped by a group of around twelve people. After the fourth, she had lost consciousness; they sat her on the fire. She arrived with very severe burns. I showed the photos of her wounds to my contact at MSF and she contacted HRW (2), which went to meet the victims and published the facts.

Since then, all the top UN officials, all the ambassadors and leading figures from the EU have been here. Several ministers came from Belgium, some French ministers came too, and even Hillary Clinton. But nothing has changed. I sometimes feel overcome by a huge sense of discouragement; I ask myself, what am I doing here? But it is the women that give us the strength to carry on, their ability to pick themselves up and continue to fight for life and for their children. They are traumatised in their own way, and we are also traumatised in our own way, but we are fighting together so that these women can regain their rights.

Do you think that the level of violence is falling?

The year 2004 was the worst, when the rapes were the most widespread. But the fact is that the number of rapes fluctuates with the movement of the troops and the areas they want to control. This year, up until April, we had the impression that things were improving, but since June, July, it has started up again... the root of the problem is still there.

What solutions do you think are likely to bring this type of violence to an end?
The humanitarian solution is not the way out. We have been working for 10 years. Some women are raped once, twice, and then the third time they refuse to leave the hospital as they are terrified at the thought of it happening again. They have HIV/AIDS, their children too. What can I say to them? I cannot keep everyone here; it’s an unbearable situation.

The Hutus arrived in 1994, their children who were five at the time are now aged 21. All the young children that came to Congo are now men capable of holding a gun, pillaging, raping and destroying. These children are all associated with those who carried out the genocide, and this is used as a pretext for persecuting them. These young people know that if they go back to Rwanda, they’ll be risking their lives. If they stay here, they are prey to the incursions of Rwandese troops, sent in to hunt them down and kill them. They have no status, they are neither refugees, nor Congolese, nor Rwandan. It is dreadful. The collective guilt placed on these young people is a time bomb. Even the children being born today are soon told that they are genocidal Hutus being hunted down by everyone.
Indeed, all those guilty of the genocide should be tracked down, their photos should be posted everywhere, and the Hutus responsible for carrying out atrocities in Congo should also be pursued. But following the genocide in Germany, the entire German population was not condemned. If we point to an entire community as being guilty, justice cannot be done. Individual charges are needed to avoid impunity.

But all the rest, all those not identified as leaders or as those who planned the genocide, should be able to choose between becoming a refugee in Congo, under the status and protection of the HCR, or going back to Rwanda and recovering their citizenship, with all the rights and obligations that entails, or requesting international asylum.

The responsibility also lies with the Congolese State, which has proved incapable of dealing with these people who have killed, raped and destroyed local communities. A month ago, two children aged between 10 and 11 were killed at point-blank range right next to here, and nothing was done!

We do not have a genuine army. They haven’t been trained, they have no sense of responsibility. Fifteen to twenty percent of women are raped by those who are supposed to be protecting them. We need to get rid of this "Godless and lawless" spirit in the army and replace it with a sense of protection towards our people.
Why not use part of MONUSCO’s budget to train young recruits that have never been involved in a conflict? Military training has been given to men aged 45 that had already fought for several factions! The record of those being trained must be checked. The old soldiers could be given early retirement, sent back to barracks and taught a trade, taught to work the land, for instance.

The leaders of these countries are a party to the illegal exploitation of minerals, which are taken out of the country by truck, for everyone to see. Seventy percent of the coltan needed for mobile phones is produced here. All these leaders profit from this "non-war, non-peace" situation.

There is a new U.S. law on the supply of raw materials. Europe should take the same measures to control the origin of raw materials.

Kabila must be pressed to take control of the mines, as a starting point for having our own operations. This takes us back to the need for an effective army.
The leaders of Congo, Rwanda and Uganda must be made to act responsibly towards their populations. Why is it that Charles Taylor or Bechir find themselves on trial whilst others, with the blessing of the United States, are allowed to massacre their own people or the neighbouring country’s people? Did Charles Taylor leave as many victims as the massacres in Congo? From the ordinary soldier to the people at the very top, everyone must be accountable for their actions.

Sometimes our patients reduce us to tears. We see that everything is damaged, that she cannot control her urine or faeces, that she no longer has a vagina. She goes back home and they do the same to her again, I’m never done with sewing, and sewing again, there’s no end to it. It makes no sense to have to operate on the same person twice or three times! All the children you see around here are born out of rapes, and carry HIV/AIDS.

Our leaders must take action. All the leaders in the Great Lakes region need to be pressed to assume their responsibilities and be accountable for their actions. Human rights here are nonexistent. People kill, rape, pillage... with total impunity!
Interview by Natacha David

Opened in 1999, Panzi hospital in Bukavu (South Kivu) has 400 beds (80 of which are for victims of sexual violence). It has around ten visits from victims of sexual violence every day, 30% of whom require major surgery. As there are not enough beds to keep the patients in for convalescence, they are sent to one of the three transit homes.

With the help of UNICEF, the hospital runs mobile clinics for victims of sexual violence, HIV/AIDS, fistula, etc. Thanks to these home visits, the women are saved the long, exhausting walk to the far-away hospital, and the social stigma is kept to a minimum.

The hospital provides training for doctors, nurses and obstetricians, and specialises in vaginal reconstruction.

It provides the patients with meals as, although it is customary for the family to feed the patient, these women often come from far away, and have no means at all. The same is the case for AIDS sufferers, who are often outcast by their families, but need to eat to build up their strength.

Some patients are hospitalised to treat serious pathologies after having been abducted for long periods and used as sex slaves by armed groups.

A psycho-social service works extensively to help prevent family break ups, trying to stop husbands from rejecting their wives who have suffered rapes. Support for occupational training is also provided to help abandoned women find a way of making a living and returning to their villages with their heads held high.

In 2008, Dr Denis Mukwege, director of Panzi hospital, received the Olof Palme prize and the United Nations human rights prize.

(1) Médecins Sans Frontières

(2) Human Rights Watch