For the last 22 years, systematic rapes and punitive violence against women in the Democratic Republic of Congo (DRC) were utilized as weapons of war and a control strategy. This quantitative study built upon the ecological model of impact of sexual assault on women's mental health to investigate the relationship between the health impacts and chronic pain and depression among women survivors of sexual rape in eastern DRC. The sample included 156 female rape survivors, between 18-80 years old, and raped between 2010 and 2014 while residing in the conflict area. The research questions focused on the association between fistulas, other sexual rape-related injuries, post-traumatic stress disorder (PTSD), feelings of worthlessness, social rejection, support from family/friends, and chronic pain and depression among women victims of sexual rape in eastern DRC. Results from multinomial logistic regression and ordinal regression tests showed strong links between independent and dependent variables: Fistula was strongly linked with chronic illness over 6 months (p = 0.003), and with upset all the time (p = 0.033); PTSD was associated with chronic illness due to violent rapes (p = 0.004) and sadness (p = 0.000); feelings of worthlessness was related to prolonged illness over 6 months (p = 0.024) and feeling blue (p = 0.006); social rejection was linked to avoidance (p = 0.003); and support from family/friends was associated with prolonged illness over 6 months (p = 0.025) and lack of excitement (p = 0.011). The results of this study could assist health care providers in formulating response strategies for identifying public health priorities in conflict area, addressing health needs, and defining approaches for reducing war-related sexual violence, chronic pain, and depression among rape survivors.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Sexual violence against women (SVAW) has always been part of armed conflict. However, only recently has international law deemed it a crime against humanity and a genocidal crime, thus finally recognising that it is a strategy and weapon that is used extensively during conflict. SVAW and its consequences, however, also continue in the aftermath of conflict, with both ex-combatants and civilians perpetrating SVAW. The effectiveness of SVAW as a weapon and strategy relies on the existence of gender identities and relations that subjugate women. This gender inequality is instated and perpetuated through hegemonic masculinity and patriarchy, and violence against women is one way in which the imbalance is enforced. Patriarchal beliefs and structures, combined with a form of militarised hypermasculinity, lead to SVAW being used during armed conflict, but also continuing in its aftermath. The consequences for survivors are that they are often stigmatised and discriminated against by their husbands, families and communities, and this contributes to their further marginalisation and exploitation. As the state and international security and peacekeeping bodies fail to adequately address SVAW, civil society organisations (CSOs) tend to fill this void by providing mostly support to women affected. One sector of African civil society, namely African Christian churches, has a good record of effectively filling roles usually associated with the state. Furthermore, African Christian churches have increased tremendously in the last century, function at grassroots-level, and are of the few CSOs that continue functioning during armed conflict. As religious institutions they have authority and impact, for religion has the ability to influence behaviour, facilitate societal change, and provide societal solidarity and cohesion. Thus, for the marginalised in Africa, religion is a powerful resource. This leads one to assume that churches can be effective in addressing SVAW. This supposition was tested by studying how churches address SVAW in three different areas affected by armed conflict, namely the Democratic Republic of Congo, Rwanda and Liberia, by using a qualitative, multiple-case case study approach. In two sites in each country, one urban and one rural, structured interview questionnaires, semi-structured interviews, and nominal groups were done, focusing on the causes and consequences of SVAW and how it is being addressed, specifically by churches. The findings showed that SVAW in areas affected by armed conflict are due to patriarchal structures and beliefs, and the military hypermasculinity that has infused civilian masculinities. Patriarchy is also the indirect cause of the most severe consequences of SVAW. These are physical, psychological, social and economic, but the impact of the stigmatisation and discrimination that survivors experience is what they find most debilitating. Unfortunately, neither government nor civil society is addressing SVAW to any great extent and where they do, their actions are reactive not proactive in terms of prevention. This was no different in terms of the role and influence of the churches. While people believe in the ability of churches to be important actors in addressing SVAW, churches are not doing so, for they, too, are patriarchal institutions. Their ability to address injustice is limited when the cause of the injustice are practices and beliefs that lie at the heart of the religion and the churches, especially if these practices and beliefs are upholding the power of those currently in power. By perpetuating patriarchy, churches are actually contributing to SVAW being used as a weapon and strategy of warfare. / AFRIKAANSE OPSOMMING: Seksuele geweld teen vroue (SGTV) was nog altyd deel van gewapende konflik. Dis egter eers onlangs wat internasionale wetgewing bepaal het dat dit ‘n misdaad teen die mensdom en van volksmoord is, en sodoende uiteindelik erken dat dit ‘n veelgebruikte konflikstrategie en -wapen is. SGTV en die gevolge daarvan hou egter aan ná konflik, met beide gewese vegters en burgerlikes wat SGTV pleeg. Die doeltreffendheid van SGTV as 'n wapen en strategie berus op geslagsidentiteite en -verhoudings wat vroue onderwerp. Hierdie geslagsongelykheid word ingestel en voortgesit deur hegemoniese manlikheid en patriargie, en geweld teen vroue is een manier waarop die wanbalans afgedwing word. Patriargale oortuigings en strukture, gekombineer met 'n vorm van militêre hipermanlikheid, lei daartoe dat SGTV nie net tydens gewapende konflik plaasvind nie, maar ook daarna. Die oorlewendes word dikwels gestigmatiseer en teen gediskrimineer deur hulle mans, families en gemeenskappe, en dit dra by tot hulle verdere marginalisering en uitbuiting. Aangesien die staat en internasionale veiligheids- en vredesliggame versuim om SGTV voldoende aan te spreek, is burgerlike organisasies (BOs) geneig om hierdie leemte te vul deur die verskaffing van meesal steun aan vroue wat deur SGTV geaffekteer word. Een sektor van Afrika se burgerlike samelewing, naamlik Afrika Christelike kerke, het 'n goeie rekord as dit kom by die vervulling van rolle wat gewoonlik geassosieer word met die staat. Verder het Afrika Christelike kerke geweldig toegeneem in die laaste eeu, funksioneer hulle op voetsoolvlak, en is hulle van die min BOs wat aanhou funksioneer tydens gewapende konflik. As godsdienstige instellings het hulle gesag en invloed, aangesien godsdiens die vermoë het om gedrag te beïnvloed, gemeenskapsverandering te fasiliteer, en solidariteit en samehorigheid aan ‘n gemeenskap te verskaf. Dus, vir gemarginaliseerdes in Afrika, is godsdiens 'n kragtige hulpbron. Dus neem ‘n mens aan dat kerke effektief kan wees in die aanspreek van SGTV. Hierdie veronderstelling is getoets deur te kyk na hoe kerke SGTV aanspreek in drie areas wat geraak word deur gewapende konflik, naamlik die Demokratiese Republiek van die Kongo, Rwanda en Liberië, deur die gebruik van 'n kwalitatiewe, meervoudige-geval gevallestudie benadering. In twee gemeenskappe in elke land, een stedelike en een landelike, is gestruktureerde onderhoudvraelyste, semi-gestruktureerde onderhoude, en nominale groepe gedoen, met ‘n fokus op die oorsake en gevolge van SGTV en hoe dit aangespreek word, spesifiek deur kerke. Die bevindinge het getoon dat SGTV in gebiede geraak deur gewapende konflik, te wyte is aan patriargale strukture en oortuigings, en die militêre hipermanlikheid wat verweef geraak het met burgerlike manlikheid. Patriargie is ook die indirekte oorsaak van die mees ernstige gevolge van SGTV. Hierdie gevolge is fisies, sielkundig, maatskaplik en ekonomies, maar die impak van die stigmatisering en diskriminasie wat oorlewendes ervaar affekteer hulle die ergste. Ongelukkig spreek nie die regering óf burgerlike samelewing werklik SGTV aan nie, en waar hulle dit doen is hulle optrede reaktief en nie proaktief in terme van voorkoming nie. Dit was dieselfde met die rol en invloed van kerke. Terwyl mense glo in die vermoë van kerke om ‘n kernrol te speel in die aanspreek van SGTV, doen kerke dit nie, want hulle is óók patriargale instellings. Hulle vermoë om onreg aan te spreek is beperk wanneer die oorsaak van die onreg praktyke en oortuigings is wat aan die hart lê van die godsdiens en die kerke, veral as hierdie praktyke en oortuigings verseker dat dié in beheer hulle mag behou. Deur hulle voortsetting van patriargie, dra kerke by daartoe dat SGTV gebruik word as 'n wapen en strategie van oorlogvoering.