[pt] A dissertação presente tem como tema os casos de abuso e exploração sexual (AES) cometidos por militares em operações de paz da ONU. Na década de 90, com o aumento das funções exercidas, e, consequentemente, do número de tropas empregadas, as denúncias de má-conduta sexual tornam-se, em várias missões das Nações Unidas, cada vez mais numerosas. A situação de pobreza extrema e de vulnerabilidade em que se encontram a maioria das mulheres e meninas dos países-hospedeiros, a sensação de impunidade e a grande disparidade de recursos entre militares e habitantes locais têm como consequência uma série de relações sexuais explorativas, que vão desde o envolvimento com prostitutas à formação de relacionamentos mais duradouros. Tais interações sexuais têm uma série de consequências negativas não só para as vítimas, mas também para a credibilidade da missão e da própria ONU. Após anos de inércia institucional, o tema ganha, em 2002, espaço relevante nas políticas da Organização, que introduz diversas medidas em combate ao AES. Tais políticas, no entanto, têm efetividade limitada frente às imunidades dadas a militares e civis em missões de paz. Em face dos entraves das medidas punitivas, a pesquisa tem por objetivo verificar a hipótese de que o treinamento sobre AES implementado nos países contribuintes de tropas possa ser uma ferramenta eficiente na diminuição de tais casos. Para isso, analisaremos os treinamentos ministrados no Exército e na Marinha do Brasil - principal país contribuinte de tropas para a Missão de Estabilização das Nações Unidas no Haiti (MINUSTAH)- e no Exército da Índia - o maior fornecedor de militares para a Missão das Nações Unidas na República Democrática do Congo (MONUC). / [en] The present thesis focuses on sexual abuse and exploitation (SEA) committed by members of the military components of United Nations peacekeeping operations. In the 1990s, with the increase of the tasks exercised by, and the number of troops in peacekeeping operations cases of SEA became ever more numerous. The extreme poverty and vulnerability from which most of the women and girls in peacekeeping host countries find themselves, the impunity of UN soldiers and the huge disparity between their resources and those of local populations has as a consequence a number of forms of exploitative sexual relationships, that go from the use of prostitutes to more longterm arrangements. Such sexual interactions have a series of negative consequences not only for the victims, but also for the credibility of UN missions and of the Organization itself. After years of institutional inertia, the subject eventually gained some profile within UN policy, with the introduction of a series of measures to combat SEA. Nevertheless, these policies have shown limited effectiveness faced with the immunity granted to the soldiers in question. Given these limitations, the research upon which this thesis is based has as a goal the verification of the hypothesis that the training on SEA implemented in the troop-contributing countries can be an effective tool in combating these crimes. To do so, it analyzes the training implemented in Brazil s Army and Navy- which furnish the lead contingent of the United Nations Stabilization Mission in Haiti (MINUSTAH), and in the Indian Army - the main troop contributing country to the United Nations Mission in the Democratic Republic of Congo (MONUC).

Cette thèse porte sur l'implantation missionnaire en République démocratique du Congo sous l'administration coloniale belge vers la fin du XIXe siècle. Nous voulons comprendre le phénomène observé de la dépendance financière de cette Église, en situant ses différentes causes ou facteurs exogènes et endogènes notamment son ancrage dans la politique coloniale. Dès le début, elle a bénéficié des subventions de l’État et d'autres avantages importants, dont de vastes étendues de terres. Depuis sa prise en main par la hiérarchie autochtone, période correspondant à la décolonisation, cette Église n'arrive pas à se prendre en charge, obligée de se tourner constamment vers l'extérieur (tes organismes occidentaux de financement) pour assurer ses différents besoins. Or cette politique d'extraversion financière ne rassure plus, vu le contexte socioculturel occidental actuel (diminution des pratiques religieuses, crises financières mondiales, ...). En définitive, il faut à cette Église congolaise longtemps habituée à l'assistance de repenser une nouvelle logique d'action lui permettant de trouver d'autres possibilités pour assurer son autofinancement en vue de sa survie. L'objectif de ce travail est de montrer que des potentialités existent qu'elle peut exploiter: la mobilisation et la gestion rationnelle des ressources humaines et économiques disponibles, la rentabilisation des structures de productions héritées des missionnaires, mais en comptant sur un environnement sociopolitique et économique national favorable et un changement des mentalités des acteurs en présence. / This thesis focuses the missionary presence in the Democratic Republic of Congo under the Belgian rule towards the end of the Sixth Century. We seek to understand bow this Church came to be financially dependent by looking at the different causes or exogenous and endogenous as well as the roots of this phenomenon within the context of the colonial policy. From the beginning, it has received State subsidies and enjoyed other significant advantages including large tracts of land. Ever since the native hierarchy has taken over, i.e. as from the decolonization, this Church has been unable to support itself and has been obliged constantly seek external aid from western financial bodies in order to meet its needs. But in the light of the current western sociocultural context (decline of religious practices, financial crises worldwide ... ) such a financial extraversion is no longer comforting. Ali things considered, long accustomed as it was to be assisted, this Congolese Church now needs to develop a new course of action through which it will be able to find other means of self-support for its survival. The objective of this work is to show that there is potential at band, namely the mobilization and the rational management of the human and economic resources available, the cost-effectiveness of the production facilities inherited from the missionaries, but resting on a favourable national sociopolitical and economic environment and a change in the attitude of the parties involved.

The thesis focuses on analysis of causes of armed conflicts within security complex of the African Great Lakes region. Explored period is situated between 1990 and present. The major part of text is devoted concrete analysis of causes of conflicts according to sector approach. The thesis attempts to describe main causal frameworks of conflicts within researched area eventually to find some their common features.

Since the 1990s the Great Lakes Region has continued to be mired in intractable conflict, with the Democratic Republic of the Congo (DRC) being at the center of it. The aim of this study is therefore an attempt to understand how the InternationalConference of the Great Lakes Region has fared in the transformation of conflict in the region, through its attempts in the DRC. For the purpose of the study, conflict transformation as presented by John Paul Lederachwas used as a theory of analyzing the selected peace efforts by the ICGLR. Furthermore, the data used in the study were secondary data which consists of archival records and documentation. The study revealed two key issues in the ICGLR’s approach to peace attempts in DRC; it showed that there are gaps in the conflict transformation approach of the earlier attempts by the ICGL, which favored more political solutions. Secondly, a rethink of the approach revealed a much more robust approach, which seeks to address not only the political conflicts but also seeks to address the historical and structural conflicts in the region. However, with the positive change in the approach, there are still high levels of conflict in the DRC.

[pt] Esta dissertação analisa como a Organização das Nações Unidas (ONU) tenta estabilizar e justificar um significado ambivalente de proteção e seus papéis sociopolíticos na agenda de Proteção de Civis (PoC). Atravessada por diferentes noções de tradução, esta pesquisa toma os Assistentes de Ligação Comunitária (CLAs) como um prisma analítico para complexificar os esforços para construir representações de proteção. Os CLAs, criados juntamente com a Missão das Nações Unidas para a Estabilização da República Democrática do Congo (MONUSCO), são funcionários locais encarregados de melhorar o engajamento da missão com a população local nas atividades de PoC, dadas as suas supostas habilidades linguístico-culturais. Assim, os CLAs também são parte do movimento das missões de estabilização na doutrina da ONU. Essa virada sinaliza a utilização de táticas de contra insurgência, cujo entendimento sobre linguagem e a cultura como armas objetiva obter inteligência e o apoio da população local. Seguindo uma abordagem pós-estruturalista e pós-colonial particularmente inspirada nas obras de Jacques Derrida e Homi K. Bhabha, esta dissertação se propõe a desconstruir as representações aplicadas aos CLAs por meio da análise dos discursos presentes nos relatórios e documentos doutrinários da ONU. Para tal, investiga-se como se espera que os CLAs traduzam linguisticamente e/ou culturalmente a visão de proteção da ONU para a população local. Nesse sentido, esta pesquisa promove diálogos com os Estudos de Tradução e Interpretação ao explorar o caráter político da tradução para as Relações Internacionais ao mesmo tempo que se aprofunda em um ator geralmente negligenciado na doutrina da ONU e nos Estudos de Operações de Paz. / [en] This thesis analyzes how the United Nations (UN) attempts to stabilize and justify an ambivalent meaning of protection and its sociopolitical roles in the Protection of Civilians (PoC) agenda. Traversed by different notions of translation, this research takes the Community Liaison Assistants (CLAs) as an analytical prism to complexify the efforts to construct representations of protection. The CLAs, created alongside the United Nations Stabilization Mission in the Democratic Republic of the Congo (MONUSCO), are local staff tasked with improving the mission s engagement with the local population in PoC activities, given their supposed linguistic-cultural skills. Thus, the CLAs are also part of the stabilization missions movement in UN doctrine. This turn signals the use of counterinsurgency tactics, whose understanding of language and culture as weapons seeks to obtain intelligence and support of the local population. Following a poststructuralist and postcolonial approach inspired mainly by the works of Jacques Derrida and Homi K. Bhabha, this thesis proposes deconstructing the representations applied to the CLAs through the analysis of the discourses presented in the UN reports and doctrinal documents. To this end, it is investigated how the CLAs are expected to translate linguistically and/or culturally the UN vision of protection to the local population. In this sense, this research promotes dialogues with Translation and Interpretation Studies by exploring the political character of translation for International Relations while delving into a generally denied actor in UN doctrine and Peace Operations Studies.

Denna studie beskriver utmaningar för socialt arbete mot barnarbete inom ASM-gruvarbete i Afrika. Detta är gjort genom en strukturerad litteraturöversikt där nio av 192 artiklar valdes ut, vilka tillsammans redovisar en översikt av existerande data. Uppsatsen är ämnad att tematiskt analysera omständigheter kring barnarbete i gruvor i Afrika, och hur förhållandet gällande socialt arbete mellan västerländska och afrikanska länder kan förstås avseende barn som arbetar med mineralbrytning i Afrika. Förhållandet mellan Afrika och västvärlden konkretiseras genom Demokratiska republiken Kongo (DRK) och koboltkedjan. Utgångspunkten för studien är barnkonventionen. Analysen diskuterar vad som behöver tas i beaktning för att uppnå hållbara förändringar. Studiens slutsats är att perspektiv på barnets bästa och barnarbete skiljer sig beroende på social kontext, vilket leder till utmaningar för socialt arbete mot barnarbete. Samarbetet mellan västvärlden och Afrika behöver stärkas än mer för att uppnå hållbar utveckling. / This study depicts challenges in social work against child labour in artisanal and small-scale mining (ASM) in sub-Saharan Africa. It is made through a structured review where nine of 192 articles were selected, which together provides an overview of existing data. The paper is aimed to thematically analyze circumstances of child labour in mines in Africa, and how the relationship of social work between Western and African countries can be understood regarding children mining in Africa. The relationship between Africa and the Western world is concretized through the Democratic republic of Congo (DRC) and the cobalt chain. The approach in this article is based on the Convention on the Rights of the Child. The analysis discusses what should be considered to achieve sustainable changes. It concludes perspectives on best interest of the child and child labour differs depending on the social context, leading to challenges for social work against child labour. Greater cooperation between the western world and Africa is needed for sustainable development.

This dissertation scrutinises two related claims that were particularly heightened in 2009 as the European Union (EU) was celebrating the first tenth anniversary of its European Security and Defence Policy (ESDP), the implementing arm of its Common Foreign and Security Policy (CFSP). First, the two policy frameworks allegedly embodied sufficient added value for bettering EU intervention for human protection purposes in third places. Second, the ESDP supposedly enabled the EU to make a difference in its response to two bloody wars that broke out in the Democratic Republic of Congo (DR Congo) successively in 1996 and 1998. This thesis argues that the alleged added value and difference have been overstated at best. While various studies have taken a similar position, they have important shortcomings for at least four reasons: lack of a comprehensive account of the CFSP motives, capacities, and response; exclusive focus on civil and military operations; focus on the post-Second Congo War period; and a lack of conceptual clarity regarding two key terms – ‘conflict resolution’ and ‘peacebuilding’. This thesis goes beyond generalisation and undertakes a forensic examination of the CFSP statements, decisions, and actions precisely through the lens of Conflict Resolution (CR): a specific subject area of study with its own normative, theoretical, and practical advantages and shortcomings; and with a more comprehensive and indeed seminal conceptualisation of peacebuilding. The outcome is a far more nuanced assessment of failure and success of the EU’s peace endeavours in this context than can be obtained through a broad-brush approach to analysis / European Community-funded Sustainable Peacebuilding (SPBUILD) Research Training Network; University of Deusto’s ‘RETOS’ research group on socio-cultural and human rights challenges in a changing world.

Conflicts have been present in the eastern Democratic Republic of Congo (DRC) for many decades. The demand for the country's natural resources in combination with unstable state power and the presence of armed groups are the reasons why sexual and gender-based violence (SGBV) has continued to petrify the local communities. It is used as a systematic weapon to terrorize, humiliate, and intimidate civilians and to destroy communities and families. The aim of this study is thus to investigate the conditions for reproduction of SGBV in DRC as well as its individual and structural consequences. The results of this literature study are analyzed based on the following theoretical approaches: doing gender, toxic masculinity and “the established and the outsiders”. The study, with an integrative approach, shows that there are numerous consequences both for the women and the society, including for example fistulas, gunshot wounds, death, anxiety, depression, rejection, and stigmatization. The results also show that the efficiency depends, among other things, on how culturally integrated the sexual violence is and that it is allowed to reproduce due to gender norms. The violence has unifying effects on members of the armed groups where hypermasculine characteristics are rewarded. Overall, it can be stated that the situation is complex and SGBV is a destructive element in the conflict. The violence is a consequence of prevailing structures while contributing to their maintenance. The study therefore contributes with knowledge about the driving factors behind sexual violence in war and shows the importance of gender norms in its reproduction. / I östra Demokratiska republiken Kongo (DRK) har konflikter varit närvarande i många decennier. Konflikten om landets naturresurser, i kombination med en instabil statsmakt och närvaron av beväpnade grupper är anledningen till att användandet av sexuellt våld fortsatt lamslå lokalsamhällen. Det används som ett systematiskt vapen för att terrorisera, förödmjuka och skrämma civila och för att splittra samhällen och familjer. Syftet med studien är att förstå och förklara vilka faktorer som reproducerar brukandet av sexuellt våld som ett vapen i krig samt dess individuella och strukturella konsekvenser. Detta görs genom en litteraturstudie och resultaten analyseras utifrån följande teoretiska begrepp: att göra kön, toxisk maskulinitet samt etablerade och outsiders. Litteraturstudien, som har ett integrativt förhållningssätt, visar att det finns många konsekvenser både för kvinnor och samhället: fistlar, skottskador, död, ångest, depression, exkludering och stigmatisering är några exempel. Resultaten visar också att effektiviteten bland annat beror på att det sexuella våldet är djupt rotat i kulturen i DRK och reproduceras av rådande könsnormer. Våldet har förenande effekter på medlemmar av de beväpnade grupperna där hypermaskulina egenskaper premieras. Sammantaget kan det konstateras att situationen är komplex och det sexuella våldet är ett mycket destruktivt inslag i konflikten. Våldet är en konsekvens av rådande strukturer samtidigt som det bidrar till upprätthållandet av dem. Studien bidrar därför med kunskap om de drivande faktorerna bakom sexuellt våld i krig samt visar på könsnormers betydelse för reproduktionen av det.

國際社會目前面臨如何減少全世界難民數量的問題，同時也面臨許多難民帶來的問題。為了要使國際社會的難民問題得到緩解，越來越多的國際人道救援機構在難民問題相當嚴重的區域，進行著人道救援行動，期望能改善大多數難民的生活狀況，並在許多方面給予難民支援，最終目標希望能根本減少全世界的難民數目，或是讓難民也能正常生活。 剛果民主共和國正是目前國際人道救援行動的主要目標之一，因為剛果民主共和國的鄰國多為長期內戰衝突的國家，因此有大量的難民逃至剛果民主共和國境內。再加上剛果民主共和國內部的種族衝突也在大國因為自身國家利益考量，未能及時阻止衝突蔓延的情況下，剛果民主共和國內戰也延續了十年，造成剛果民主共和國政府自身難保，而境內的難民問題亦日趨嚴重。 為協助剛果民主共和國政府處理相關的難民問題，國際人道救援行動投入大量人力與物力安頓難民的生活，並協助逃往國外的難民回到剛果民主共和國境內。在聯合國安理會的維和部隊，以及國際人道救援機構，如聯合國難民署與人權觀察等組織的協助之下，受到剛果民主共和國內戰衝突的難民，皆逐漸在剛果民主共和國境內衝突趨緩之際，重新回到家園或原居住地生活。而藉著國際人道機構對於剛果民主共和國難民的救援行動，也發現國際人道救援救援網絡漸形完整，因而一方面讓許多原本隱而不顯的人道危機，得到更多外界的關心與幫助，使國際人道救援行動能更加順利，快速改善當地的難民處境，另外一方面則也顯現出國際人道救援機構在難民問題上的重要地位。 / International society now is facing the difficulties of how to reduce the number of refugees and also the problems that caused by refugees. To help the refugees, more and more international humanitarian aid agencies conducting the humanitarian aid operations in the conflict zones. Their operations are to ameliorate the conditions of refugee’s life and the most important thing is help them repatriated to their homeland. The bloody conflict in Democratic Republic of Congo (DRC) made the international humanitarian aid agencies aware that the government of DRC had no ability to manage the influx of the refugees from neighbors. So the humanitarian aid agencies spend lots of energy to help the refugees from DRC or in DRC to be repatriated or to help them integrate with locals. On the aid operations that international humanitarian aid agencies did to the refugees in DRC, we found that the network of international humanitarian aid becomes more and more complete. Those operations helped gather more attention from publics, so we can avoid the humanitarian crisis in the future or make the refugee’s situations better. And the importance of international humanitarian aid agencies is also evident in the case of refugee problem in DRC.

Problématique : Depuis bientôt deux décennies, la République Démocratique du Congo (RDC) est le territoire d’un conflit armé qui, selon l’International Rescue Commite, aurait occasionné plus de 3 millions de décès et autant de déplacés internes. Plusieurs rapports font également cas des nombreux actes de violence sexuelle (les viols, les mutilations, l’esclavage, l’exploitation sexuelle, etc.) commis envers les filles, les femmes et dans une moindre ampleur les hommes. S’il existe un consensus sur le côté barbare des actes de violence sexuelle liés aux conflits armés, rares sont les études qui ont évalué leurs conséquences sur la santé reproductive des survivantes surtout en termes d’issues telles que les fistules, les douleurs pelviennes chroniques (DPC), le désir de rapports sexuels, le désir d’enfant et le désir d’interruption de la grossesse issue de tels actes. Par ailleurs, même si la santé mentale des populations en zones de conflit représente un sujet d’intérêt, l’impact spécifique de la violence sexuelle liée au conflit sur la santé mentale des survivantes a été peu étudié. De plus, ces travaux s’intéressent aux effets de la violence sexuelle liée au conflit sur la santé mentale et sur la santé reproductive séparément et ce, sans évaluer les relations qui peuvent exister entre ces deux dimensions qui, pourtant, s’influencent mutuellement. Aussi, l’impact social de la violence sexuelle liée au conflit, ainsi que la contribution des normes socioculturelles aux difficultés que rencontrent les survivantes, a été peu étudié. Pourtant, l’impact social de la violence sexuelle liée au conflit peut permettre de mieux comprendre comment l’expérience d’un tel acte peut affecter la santé mentale. Enfin, aucune étude n’a évalué les effets de la violence sexuelle liée au conflit en la comparant à la violence sexuelle non liée au conflit (VSNLC). Pourtant, il est reconnu qu’à de nombreux égards, la violence sexuelle liée au conflit est bien différente de la VSNLC puisqu’elle est perpétrée avec l’intention de créer le maximum d’effets adverses pour la victime et sa communauté. Objectifs : Les objectifs poursuivis dans cette thèse visent à : 1) évaluer les effets de la violence sexuelle liée au conflit sur la santé reproductive; 2) évaluer les effets de la violence sexuelle liée au conflit sur la santé mentale en termes de sévérité des symptômes de stress posttraumatique (PTSD), de sévérité des symptômes de détresse psychologique et de probabilité de souffrir de troubles mentaux communs (TMC); 3) évaluer la contribution des troubles physiques de santé reproductive, en particulier les fistules et les douleurs pelviennes chroniques (DPC), aux effets de la violence sexuelle liée au conflit sur la santé mentale; 4) évaluer la contribution de l’état de santé mentale aux effets de la violence sexuelle liée au conflit sur le désir de rapports sexuels et le désir d’enfant; et 5) étudier l’impact de la violence sexuelle liée au conflit sur le plan social ainsi que la contribution des normes socioculturelles à ses effets adverses et la façon dont ces effets pourraient à leur tour influencer la santé des femmes et leur relation avec l’enfant issu de l’acte de violence sexuelle subi. Méthodologie : Un devis mixte de nature convergente a permis de collecter des données quantitatives auprès de l’ensemble des participantes (étude transversale) et des données qualitatives sur un nombre plus restreint de femmes (étude phénoménologique). Une étude transversale populationnelle a été conduite entre juillet et août 2012 auprès de 320 femmes âgées de 15 à 45 ans habitant quatre (4) quartiers de la ville de Goma située dans la province du Nord-Kivu en RDC. Les femmes ont été recrutées à travers des annonces faites par les responsables des programmes d’alphabétisation et de résolution de conflits implantés dans les différents quartiers par le Collectif Alpha Ujuvi, une ONG locale. Les issues de santé reproductive évaluées sont : les fistules, les DPC, le désir de rapports sexuels, le désir d’enfant et le désir d’interruption de la grossesse issue d’un acte de violence sexuelle. Les variables de santé mentale d’intérêt sont : la sévérité des symptômes de détresse psychologique, la sévérité des symptômes de PTSD et la probabilité de souffrir de TMC. Pour les analyses, l’exposition a été définie en trois (3) catégories selon l’expérience passée de violence sexuelle : les femmes qui ont vécu des actes de violence sexuelle liée au conflit, celles qui ont vécu des actes de VSNLC et celles qui ont déclaré n’avoir jamais subi d’acte de violence sexuelle au cours de leur vie. Les variables de confusion potentielles mesurées sont : l’âge, le statut matrimonial, le nombre d’enfants, le niveau d’éducation le plus élevé atteint et l’occupation professionnelle. Les mesures d’associations ont été évaluées à l’aide de modèles de régressions logistiques et linéaires simples et multiples. Des tests d’interaction multiplicative et des analyses stratifiées ont été également conduits pour évaluer l’effet potentiellement modificateur de quelques variables (âge, statut matrimonial, nombre d’enfants) sur la relation entre la violence sexuelle et les variables de santé reproductive ou de santé mentale. Ces tests ont également été utilisés pour évaluer la contribution d’une variable de santé reproductive ou de santé mentale aux effets de la violence sexuelle sur l’autre dimension de la santé d’intérêt dans cette étude. Une étude phénoménologique a été conduite dans le même intervalle de temps auprès de 12 femmes ayant participé à la partie quantitative de l’étude qui ont vécu la violence sexuelle liée au conflit et ont eu un enfant issu d’une agression sexuelle. Les sujets explorés incluent : la perception de l’acte de violence sexuelle liée au conflit vécu et de la vie quotidienne par les victimes; la perception de l’acte de violence sexuelle liée au conflit par la famille et l’entourage et leurs réactions après l’agression; la perception de la grossesse issue de l’acte de violence sexuelle par la victime; la perception de l’enfant issu de la violence sexuelle liée au conflit par la victime ainsi que son entourage; les conséquences sociales de l’expérience de violence sexuelle liée au conflit et les besoins des victimes pour leur réhabilitation. Une analyse thématique avec un codage ouvert a permis de ressortir les thèmes clés des récits des participantes. Par la suite, l’approche de théorisation ancrée a été utilisée pour induire un cadre décrivant l’impact social de l’expérience de la violence sexuelle liée au conflit et les facteurs y contribuant. Résultats : Le premier article de cette thèse montre que, comparées aux femmes qui n’ont jamais vécu un acte de violence sexuelle, celles qui ont vécu la violence sexuelle liée au conflit ont une probabilité plus élevée d’avoir une fistule (OR=11.1, IC 95% [3.1-39.3]), des DPC (OR=5.1, IC 95% [2.4-10.9]), de rapporter une absence de désir de rapports sexuels (OR=3.5, IC 95% [1.7-6.9]) et une absence de désir d’enfant (OR=3.5, IC 95% [1.6-7.8]). Comparées aux mêmes femmes, celles qui ont vécu la VSNLC ont plus de probabilité de souffrir de DPC (OR=2.3, IC 95% [0.95-5.8]) et de rapporter une absence de désir d’enfant (OR=2.7, IC 95% [1.1-6.5]). Comparées aux femmes qui ont vécu la VSNLC, celles qui ont vécu la violence sexuelle liée au conflit ont également une probabilité plus élevée d’avoir une fistule (OR=9.5, IC 95% [1.6-56.4]), des DPC (OR=2.2, IC 95% [0.8-5.7]) et de rapporter une absence de désir de rapports sexuels (OR=2.5, IC 95% [1.1-6.1]). En ce qui concerne les grossesses issues des viols, comparées aux femmes qui ont vécu la VSNLC, celles qui ont vécu la violence sexuelle liée au conflit sont plus nombreuses à souhaiter avorter (55% vs 25% pour celles qui ont vécu la VSNLC). Elles sont également plus nombreuses à déclarer qu’elles auraient avorté si les soins appropriés étaient accessibles (39% vs 21% pour celles qui ont vécu la VSNLC). Le second article montre qu’en comparaison aux femmes qui n’ont jamais subi de violence sexuelle, celles qui ont vécu la violence sexuelle liée au conflit présentent des symptômes de détresse psychologique (moyennes de score respectives 8.6 et 12.6, p<0.0001) et des symptômes de PTSD (moyennes de score respectives 2.2 et 2.6, p<0.0001) plus sévères et ont plus de probabilité d’être dépistées comme un cas de TMC (30% vs 76%, p<0.0001). De plus, comparées aux femmes qui ont vécu la VSNLC, celles qui ont vécu la violence sexuelle liée au conflit présentent des symptômes de détresse psychologique (moyennes de score respectives 10.1 et 12.6, p<0.0001) et des symptômes de PTSD (moyennes de score respectives 2.2 et 2.6, p<0.0001) plus sévères et ont plus de probabilité d’être dépistées comme un cas de TMC (48% vs 76%, p<0.001). Les valeurs minimales et maximales de score de sévérité de symptômes de détresse psychologique sont de 0/12 pour les femmes qui n’ont jamais vécu de violence sexuelle, 4/19 pour celles qui ont vécu la VSNLC et de 5/18 pour celles qui ont vécu la violence sexuelle liée au confit. En ce qui concerne la sévérité des symptômes de PTSD, les scores minimal et maximal sont respectivement de 0.36/3.22, 0.41/3.41 et 0.95/3.45. Le fait d’avoir développé une fistule ou de souffrir de DPC après l’agression sexuelle augmente la force des associations entre la violence sexuelle et la santé mentale. Les femmes qui ont subi la violence sexuelle liée au conflit et qui ont souffert de fistules présentent des symptômes de détresse psychologique et de PTSD plus sévères comparées aux femmes qui ont subi la violence sexuelle liée au conflit mais n’ont pas de fistules. Les résultats sont similaires pour les femmes qui ont subi la violence sexuelle liée au conflit et qui souffrent de DPC. Des résultats complémentaires suggèrent que le statut matrimonial modifie l’effet de la violence sexuelle sur la sévérité des symptômes de détresse psychologique, les femmes divorcées/séparées et les veuves étant celles qui ont les moyennes de score les plus élevées (respectivement 11.3 et 12.1 vs 9.26 et 9.49 pour les célibataires et les mariées). Par ailleurs, la sévérité des symptômes de détresse psychologique modifie l’association entre la violence sexuelle liée au conflit et le désir d’enfant. Le troisième article montre que, sur le plan social, l’expérience de violence sexuelle liée au conflit entraine également de lourdes conséquences. Toutes celles qui ont vécu ce type d’acte décrivent leur vie de survivante et de mère d’un enfant issu d’une agression sexuelle comme difficile, oppressive, faite de peines et de soucis et sans valeur. Plusieurs facteurs influencent la description que les victimes de violence sexuelle liée au conflit font de leur vie quotidienne, et ils sont tous reliés aux normes socioculturelles qui font de la femme une citoyenne de seconde zone, ne font aucune différence entre un viol et un adultère, condamnent les victimes de violence sexuelle plutôt que leurs agresseurs, rejettent et stigmatisent les victimes de tels actes ainsi que l’enfant qui en est issu. En réponse au rejet et au manque de considération, les femmes victimes de violence sexuelle liée au conflit ont tendance à s’isoler pour éviter les insultes et à garder le silence sur leur agression. En plus, les réactions de leur entourage/communauté ont tendance à leur faire revivre l’agression sexuelle subie, autant d’éléments qui nuisent davantage à leur réhabilitation. D’autres résultats démontrent que les enfants issus d’actes de violence sexuelle liée au conflit sont également rejetés par leur communauté, leur famille adoptive ainsi que le conjoint de leur mère, ce qui affecte davantage les survivantes. Avec leurs mères, les relations développées varient entre le rejet, la résignation et l’affection. Néanmoins, ces relations sont plus souvent tendues probablement à cause de la stigmatisation de la communauté. Conclusion: La violence sexuelle liée au conflit a des effets adverses sur la santé reproductive, la santé mentale mais également sur le plan social. Ces trois dimensions sont loin d’être isolées puisque cette étude a permis de démontrer qu’elles s’influencent mutuellement. Ceci suggère que la prise en charge des victimes de violence sexuelle liée au conflit ne doit pas se concentrer sur un aspect ou un autre de la santé mais prendre en compte l’ensemble des dimensions de la femme pour offrir une aide holistique, plus adaptée et qui sera plus efficace à long terme. / Background: Since nearly two decades, the Democratic Republic of Congo (DRC) is ravaged by an armed conflict which, according to the International Rescue Commitee, have caused more than 3 million deaths and as many internally displaced persons. Several reports also denounce the numerous cases of sexual violence (rape, mutilation, sexual slavery, exploitation, etc.) committed against girls, women, and to a lesser extent against men. Even if there is a consensus on the barbaric nature of conflict-related sexual violence acts, few studies have assessed its effects on survivors’ reproductive health especially in terms of issues such as fistulas, chronic pelvic pain (CPP), desire for sex, desire for children, and desire to interrupt pregnancy resulting from rape. Moreover, even if the mental health of populations in conflict zones is a topic of interest, the specific impact of conflict-related sexual violence on the survivors’ mental health has not been much studied. In addition, most studies research the effects of conflict-related sexual violence on mental health and on reproductive health separately without assessing the relationships that can exist between these two dimensions which, however, influence each other. Also, the social impact of conflict-related sexual violence, and the contribution of sociocultural norms to the survivors’ struggles, has not been much studied. Nevertheless, the social impact of conflict-related sexual violence may help in understanding how the experience of such act can affect mental health. Finally, no study has investigated the effects of conflict-related sexual violence by comparing it to non-conflict- related sexual violence (NCRSV). However, it is recognized that, in many respects, conflict- related sexual violence is very different from NCRSV since it is committed with the intent to create the most adverse effects on the victims and their community. Objectives: The objectives of this thesis aimed at: 1) assessing the effects of conflict- related sexual violence on reproductive health; 2) evaluating the effects of conflict-related sexual violence on mental health in terms of severity of posttraumatic stress disorder (PTSD) symptoms, severity of psychological distress symptoms, and the likelihood of suffering from common mental disorders (CMD); 3) assessing the contribution of adverse reproductive health issues, particularly fistula and chronic pelvic pain (CPP) to the effect of conflict-related sexual violence on mental health; 4) assessing the contribution of mental health state to the effect of conflict-related sexual violence on desire for sexual intercourse, and desire for children; and 4) studying the social impact of conflict-related sexual violence as well as the contribution of sociocultural norms to its adverse consequences, and how these effects could in return affect women’s health and their relationship with their rape-conceived children. Methodology: A convergent mixed design allowed collection of quantitative data from all participants (cross-sectional study) and qualitative data on a smaller number of women (phenomenological study). A population-based cross-sectional study was conducted between July and August 2012 among 320 women, aged 15 to 45, living in four (4) neighbourhoods of the city of Goma, province of North Kivu in the DRC. Participants were recruited through announcements made by those responsible for literacy and conflict-resolution programs implemented in different neighbourhoods by the Collectif Alpha Ujuvi, a local NGO2. Reproductive health outcomes assessed are: fistulas, CPP, desire for sex, desire for children and desire to interrupt pregnancy resulting from sexual violence. The mental health outcomes of interest were: severity of psychological distress symptoms, severity of PTSD symptoms, and likelihood of suffering from CMD. For analyses, exposure was defined in three (3) categories according to past experience of sexual violence: women who experienced conflict-related sexual violence, those who experienced NCRSV, and those who reported never having been victim of sexual violence in their lifetime. Potential confounders assessed were: age, marital status, number of children, highest education level reached, and occupation. Measures of association were assessed using simple and multiple logistic and linear regression models. Multiplicative interaction tests and stratified analyzes were also conducted to identify the potential modification effect of the variables age, marital status and number of children on the association between sexual violence and reproductive health or mental health. Those tests were also used to assess the contribution of reproductive health or mental health to the effects of sexual violence on the other aspect of health of interest in this study. In the meantime, a phenomenological study was conducted among 12 women who experienced conflict-related sexual violence, had a rape-conceived child, and participated in the quantitative part of the study. Topics explored include: perception of the act of conflict- related sexual violence and the daily life by the victims; perception of the act of rape by the victims’ family and entourage and their reaction after the aggression; perception of pregnancy resulting from sexual violence by the victim; perception of the rape-conceived child by the victim and her entourage; social consequences of experiencing conflict-related sexual violence, and victims' needs for rehabilitation. A thematic analysis with open coding has highlighted the key themes of the participants’ stories. Thereafter, a grounded theory approach was used to induce a framework outlining the social impact of experiencing conflict-related sexual violence along with the contributing factors. Results: The first article of this thesis shows that, compared to women who have never experienced sexual violence, women who experienced conflict-related sexual violence have a higher probability to have fistula (OR=11.1, 95% CI [3.1-39.3]), CPP (OR=5.1, 95% CI [2.4- 10.9]), an absence of desire for sexual intercourse (OR=3.5, 95% CI [1.7-6.9]), and an absence of desire for children (OR=3.5, 95% CI [1.6-7.8]). Compared with the same women, those who have experienced NCRSV are more likely to have CPP (OR=2.3, 95% CI [0.95-5.8]), and an absence of desire for children (OR=2.7, 95% CI [1.1-6.5]). Compared with women who have experienced NCRSV, those who experienced conflict-related sexual violence also have higher odds for fistula (OR=9.5, 95% CI [1.6-56.4]), CPP (OR=2.2, 95% CI [0.8-5.7]), and absence of desire for sexual intercourse (OR=2.5, 95% CI [1.1-6.1]). Regarding pregnancy resulting from sexual violence, in comparison to women who experienced NCRSV, a higher proportion of those who experienced conflict-related sexual violence were willing to abort (55% vs. 25% for those who experienced NCRSV). They are also more likely to admit that they would have done so, if proper care was available (39% vs. 21% for those who experienced NCRSV). The second article shows that, compared to women who have never experienced sexual violence, those who experienced conflict-related sexual violence have more severe symptoms of psychological distress (respective score means 8.6 and 12.6, p<0.0001) and PTSD (respective score means 2.2 and 2.6, p<0.0001), and are more likely to be probable CMD case (30% vs. 76%, p<0.0001). Moreover, compared to women who experienced NCRSV, those who experienced conflict-related sexual violence have more severe symptoms of psychological distress (respective score means 10.1 and 12.6, p<0.0001) and PTSD (respective score means 2.2 and 2.6, p<0.0001), and are more likely to be probable CMD case (48% vs. 76%, p<0.0001). The lowest and highest scores of severity of psychological distress symptoms are 0/12 in the category of women who never experienced sexual violence, 4/19 in the category of women who experienced NCRSV and 5/18 in the category of women who experienced conflict-related sexual violence. Regarding the severity of PTSD’s symptoms, the lowest and highest scores are respectively: 0.36/3.22, 0.41/3.41 and 0.95/3.45. Suffering from fistula or CPP increases the strength of the association between sexual violence and mental health. Women who experienced conflict-related sexual violence and suffered fistula, compared to those who experienced conflict-related sexual violence and did not suffer from fistula, have more severe symptoms of psychological distress and PTSD. Results were similar for women who experienced conflict-related sexual violence and have CPP. Complementary results suggest that the marital status modifies the association between sexual violence and severity of psychological distress symptoms, divorced/separated and widowed being those who have the highest score means (respectively 11.3 and 12.1 vs. 9.26 and 9.49 for singles and married women). Furthermore, the severity of psychological distress symptoms changes the association between conflict-related sexual violence and desire for children. The third article shows that, on the social front, experiencing conflict-related sexual violence also results in serious consequences. All women who experienced this type of act describe their life of survivor and mother of a child born from rape as difficult, oppressive, made of worries and sorrows, and worthless. Several factors influence the description that victims of conflict-related sexual violence make of their daily lives, and they are all related to socio-cultural norms which consider women as second class citizen, do not make any difference between rape and adultery, condemn rape victims rather than the perpetrators, reject and stigmatize raped women and rape-conceived children. In response to the rejection and lack of consideration, survivors of conflict-related sexual violence tend to isolate themselves to avoid insults, and keep quiet about the aggression they suffered. In addition, the reactions of their entourage/community tend to revive memories of the aggression they suffered, all of which may impair their rehabilitation. Other results show that children resulting from conflict-related sexual violence are also rejected by their communities, as well their adoptive family and their mother’s partner and this hurts the victims. With their mothers, relationships developed range from rejection, resignation to affection. Nevertheless, these relationships are often more likely to be strained because of the stigma of the community. Conclusion: Conflict-related sexual violence has adverse effects on reproductive health and mental health. It is also associated with adverse social consequences. Those three dimensions are far from being isolated because this study demonstrated that they do influence each other. This suggests that intervention programs for victims of conflict-related sexual violence should not only focus on one aspect of health but take into account all the dimensions of a woman to provide holistic and more appropriate support which will be more effective in the long term.