Sexual and Gender-based Violence Against Children in the DRC Conflict Part 1: Statistics, Preconditions and Effects

By Ashley Dale

It is no secret that sexual and gender-based violence (SGBV) is widespread in the DRC; a place that has been dubbed the rape capital of the world and one of the most dangerous places for women and girls to live. The protracted conflict has been the deadliest since World War II spanning nearly two decades and killing roughly 5.4 million people. In June 2012, the Sonke Gender Justice Network and the Institute for Mental Health of Goma implemented a survey as part of a study on sexual violence to men and women in and around Goma in the North Kivu province of the DRC. The study found that instances of SGBV rise during times of conflict. The data gathered from the survey concluded that all people in the region are subject to SGBV including men and boys with women and girls being at the highest risk for encountering SGBV at both the household level and in the field during conflict. Given these facts, it is no surprise that SGBV, particularly rape, is used without hesitation as a key weapon of war in the DRC conflict.

Children account for a large number of actors, both direct and indirect, in the ongoing conflict that has plagued the DRC since 1996. They make up a portion of ex-combatant dependents, outside actors and victims, and child soldiers perpetrating violence and are considered a special needs group (SNG) in DDR. Coupled with the widespread use of SGBV in the DRC, it seems unfathomable that children would not be affected by sexual violence in some way throughout this conflict. In fact, the truth is that children are key targets of SGBV because of their vulnerability and societal status in which they are typically dependents and have no power to make decisions. Children and young adults under the age of 25 make up roughly 60 percent of the target demographic in conflict affected countries. One startling statistic concludes that in the first half of 2012, 74 percent of sexual violence victims and survivors treated at the HEAL hospital in Goma, DRC were children. This number could be much higher since data on this subject is difficult to collect. Many victims live in fear and/or shame and do not come forward to report their abuse. The stigma surrounding SGBV, especially in Africa and particularly in the DRC because of its rampant use, makes it extremely difficult for researchers to get concrete statistics, leaving us with only estimates of the damage done.

Several preconditions typically need to be realized in order for SGBV against children in conflict to occur. First, there is usually a breakdown in governance with a lack of institutional stability; the DRC is a prime example of this being a failed state where institutional instability (and in some cases lack of specific institutions) and lack of governance is glaring. Along the same lines, corruption and absence of rule of law are typically present as well; again this is evident in the DRC. Impunity and lack of accountability are also factors which are also evident in the DRC. A prime environment for SGBV has taken shape when these preconditions mix with communities that are unable to protect themselves, stigmatizing cultural attitudes towards rape and sexual violence, and the normalization of certain behaviors.

The results of SGBV against children in conflict and under the above mentioned conditions are many. Unwanted pregnancies, STDs, HIV, incontinence, and fistula are some of the physical effects of sexual violence against children. Psychological effects include post-traumatic stress disorder (PTSD), depression, flash backs, and drug and alcohol abuse. Some of these psychological effects have longer-term side effects including interrupted or discontinued education, forced marriage, and limited income options (e.g. sex work). SGBV destroys the social fabric of villages in the DRC where children are often rejected by their families and/or whole communities. This in turn creates fear, trust issues, and loss of confidence of the children affected. All of these factors damage children deeply and leave them with minimal hope for recovery. SGBV against children in conflict destroys families and creates breakdown in communities which is a key motivation of combatants who perpetrate this type of violence.

It is important to understand the specific war tactics used in the DRC conflict and what groups they are inflicted upon in order to understand why several DDR processes have been implemented with little success. The newest and third DDR process was recently implemented (May 2015) in the DRC, but how affective will it be in terms of addressing child ex-combatants (child soldiers) who have suffered SGBV? What approaches, if any, will be taken to help reintegrate this specific cohort (as both outside and inside actors in the conflict) of this special needs group back into society? I will address these questions in Part 2 of this blog.

Children in DDR: Lessons from Sierra Leone

By Nick Palombo

Recruiting children into governmental armed forces, or other armed groups, is illegal under international law and a violation of human rights. Seen in many conflicts, such as in Uganda, Angola, the Democratic Republic of Congo, Sierra Leone, Afghanistan, Namibia, and many others, child combatants make up a significant portion of many armed groups. Because of this it is critical that security approaches are developed, adopted, and incorporated into DDR programs that pertain to disengaging minors from militant groups in conflict settings. Children that are soldiers are first and foremost children. This fact must be the basis for all child-soldier reintegration in DDR programs.

The Cape Town Principles and Best Practices (1997) define a child-soldier as:

“Any person under 18 years of age who is part of any kind of regular or irregular armed force or armed group in any capacity, including but not limited to cooks, porters, messengers and anyone accompanying such groups, other than family members. The definition includes girls recruited for sexual purposes and for forced marriage. It does not, therefore, only refer to a child who is carrying or has carried arms.”

Incorporating child soldiers in DDR programs require a holistic and child-centered approach, founded on protecting children and honoring their rights. Children are significant to reintegration as they may re-take up arms, especially if they are returning to a situation of poverty, rejection, and socio-economic marginalization. Child-soldiers can be both combatants and non-combatants, as well as both boys and girls ranging from infants to 18. It is important that DDR procedures and peace agreements reflect their needs. This ensures that programming is tailored to suit their successful and permanent reintegrating into society. Measures should be adopted and directed at the individual child, their families, and the greater community.

The rights of children, codified in numerous international documents such as the Convention on the Rights of the Child and the Universal Declaration of Human Rights, provide a general direction for practitioners in protecting children in contexts of war. DDR for children should be driven by international legal standards, and accordingly, planned and operated by organizations with child protection central to their mandates.  All programming aimed at children should have the “best interest of the child” in mind. This will require a targeted approach that is specific to each child’s needs, which is counter-intuitive to the traditional ‘cookie-cutter’ approach that regular DDR programs usually entail. Despite many similarities, the experiences of children in conflict will always be vastly different. Therefore, the child reintegration assistance must be customized to help each child in their unique situation.

DDR programs targeting minors must be age appropriate, time-sensitive, and should include children who participated in war, as well as children who supported it, and were affected by it. According to the IDDRS, ‘child-centred reintegration is multi-layered and focuses on family reunification; mobilizing and enabling care systems in the community; medical screening and health care, including reproductive health services; schooling and/or vocational training; psychosocial support; and social, cultural and economic support’.[1] Incorporating this range of operations in DDR programs can help practitioners appropriately include child-combatants, while keeping in mind the exceptional psycho-social necessities for children in warfare. Implementing a child-centered and rights based approach is both resource-intensive and time-sensitive. Also, children do not reintegrate in isolation. Outside factors can heavily affect the process and potential success of this DDR type. Therefore a child-centered approach that focuses on strengthening the family and the community will allow for the best and most sustainable protection of a child’s welfare.

A prominent example of child soldier reintegration took place after the invasion of Sierra Leone by the Revolutionary United Front (RUF). This group became known for its extensive use of child soldiers. Through the abduction of children during village raids, the RUF forced children to commit atrocities against their own families or others to instil in them the sense that they could never return back to their village. In the time between 1991 and 2001, 10 000 children were forced to fight in Sierra Leonean armed forces (Odeh and Sullivan 2004). Children became rejected from the community, following their infliction of violence by the command of their militant groups.

The Child-Soldier DDR program in Sierra Leone focused heavily on reuniting children with family and the community, as opposed to solely the individual development of the child itself. The reason for this was because after committing such grave atrocities, child soldiers at risk of being rejected by the community. In Sierra Leonne, because children were so central to the conflict, the standard of dealing with child soldiers was at the forefront of peace operations. Laid out in a comprehensive peace agreement, the Lomé Peace Accord specified that children combatants would be given particular attention and handled differently than adults in DDR settings. One example of this difference was in allotment of cash stipends and skills training. Adult combatants were given financial packages for reintegration and incentive, as opposed to children, who were not given these in fear that holding monetary value would leave them vulnerable to their commanders. Instead, children were assisted with unifying with their families, and they were given a choice between education and skills training. In spite of this, difficulty arose when some children requested to be reintegrated as adults, while others, requesting the same, only wanted to participate to receive cash incentive.

Selection and eligibility for child-soldier DDR was a point of contention in Sierra Leone’s program. Determining the age of a child, which is conducive to determining their needs, was made very difficult for a variety of different reasons (aside from the one mentioned previously). Some children were left out of the program because they did not possess arms. Young girls experienced the greatest marginalization in this respect, as they often do in most child-soldier reintegration programs. For an abundance of reasons, such as inability to access programming, feelings of shame, ‘bush-husband’ influence, and gender bias in programming, many girls and young women were overlooked in the process. Out of the 6845 children reintegrated by 2004, 92 percent were boys and only 8 percent girls (UNICEF 2004).  A large part of this exclusion was that girls did not have weapons and therefore were turned away. An important lesson, which can be found in the IDDRS, is that child-soldier DDR programs should have alternate means for child soldiers, in particular girls, to access reintegration services that are not dependent on weapon ownership or the willingness of commanders.

Many lessons like this one can be drawn from Sierra Leonne to be applied to future projects of child-soldier disarmament, demobilization and reintegration. One is that interventions must be made on a basis that is appropriate and specific to the context that a child is engulfed. In Sierra Leone, this was through ‘community sensitization, formal disarmament and demobilization, a period of transition, family tracing and unification, mediation, traditional healing ceremonies, school and skills training, and encouragement and facilitation’ (Williamson, 192). Undoubtedly, returning children to their families was the most important aspect of child reintegration. Families played a prominent role in the sustainability of child-soldier reintegration, therefore building partnerships with these groups and the community was integral to the sustainability of disarmament.

Another lesson from Sierra Leone is that peace agreements must reflect the fact that children can be both combatants and non-combatants, and accordingly there is a need to incorporate both in the reintegration process.  Special attention to procedures and considerations regarding children must be incorporated into not only peace agreements, but also the training of peacekeepers and military observers. Additionally, young women and girls are at most risk of exclusion, therefore special attention should be given to ensure their inclusion when the process is planned and implemented.  Furthermore, even more attention, as well as humanitarian assistance, is due to young adults (both male and female) who were abducted or otherwise forced as children to become part of a militant group and as a result have been permanently socialized to war.

Understanding the needs of child-soldiers is best understood through a contextual analysis. This involves looking at the political, social, economic and cultural origins of a conflict, as well as the ideologies and structures of armed groups, recruitment targets, the living conditions of children in these groups, and the community’s feelings about the impact of the conflict on the needs of children, to best understand the caseload. DDR for children is separate and different from DDR for adults. Programming should be tailored to the needs of boys, girls, young men, and young women, aside from the normal case-load of former combatants. Since children and young people are disproportionately affected by war and conflict, their special needs must be reflected in their reintegration programs.

[1] IDDRS Chapter 5. Pg.30 http://www.iddrtg.org/wp-content/uploads/2013/05/IDDRS-5.30-Children-and-DDR1.pdf

Focal Points for Health Interventions: DDR and HIV/AIDS

By Nick Palombo

Health considerations in DDR incorporate human security, analyze key health concerns, and respond to the needs of the most vulnerable groups of ex-combatants. Major health concerns in DDR, among others, are chronic communicable diseases, HIV/AIDS, violence and injury prevention, and psycho-social support for mental health and substance abuse. However, health concerns vary greatly according to the geographical area of caseload and conflict dynamics. Types of interventions appropriate in DDR will be dependent on the number of combatants in the caseload, their relatives, the median gender and age, specific needs, and local capacities for the provision of health services.

The objective of integrating health care in DDR is to reduce the percentage of avoidable illnesses and deaths in a caseload, through basic healthcare and preventative epidemiological interventions. These include both reproductive-health and psycho-social care considerations. In all cases, there must be a minimum guaranteed basic medical screening, which should be conducted in the interim at first point of contact (disarmament and demobilization stage). However, ongoing access to healthcare and voluntary counseling and treatments must also remain available during long-term reintegration processes. Satisfying these conditions requires creating partnerships with local public health stakeholders to generate sustainable health services and long-term medical records. Health interventions in DDR are best facilitated through comprehensive partnerships with local health actors. These may include NGOs and international humanitarian agencies, like the World Health Organization (WHO), the United Nations Population Fund (UNFPA), the Joint United Nations Program on Aids (UNAIDS), and the International Committee of the Red Cross (ICRC).

A primary strategy for intervention should be treating ex-combatants in the interim. This means treating acute sicknesses and infectious diseases over chronic and non-infectious diseases. This strategy can decrease the rate of transmitted infections, and minimize the chances of co-infection in already infected individuals. Basic medical screening can permit monitoring of potential epidemiological and nutritional issues, and can build capacity for early detection as well as rapid response. Linking health interventions to DDR can take the form of many types of programming.  Therefore, the choice of programs should be based off an analysis of the political and legal arrangements of peace agreements and the specific nature of the conditions on the ground. Including and utilizing local healthcare providers can ensure that local public health concerns are taken into account. Therefore, local health sectors should be represented in all established programs to oversee the health intervention from the earliest possible stage.

When speaking to health interventions in DDR programs, it is essential to discuss HIV/AIDS infection. DDR programs frequently operate in locations with high HIV/AIDS prevalence. Ex-combatants are considered high-risk groups for infection given their age range, degree of mobility, and risk-taking behavior. Women associated with armed forces are also part of this high-risk group, given the widespread instances of sexual violence and abuse. Even child-soldiers are  part of this high-risk group, given that they are often sexually active much earlier than their non-combatant peers. Furthermore, in some conflicts, drugs are also highly prevalent. This further increases vulnerabilities by increasing risky-behavior and furthering transmissions of HIV infection. DDR providers should additionally take into account the movement of individuals across borders, and the heightened risk of epidemiological disease transmission from emigration. The best strategy for intervening on this is early detection and containment of disease in foreign ex-combatants, to intercede any potential outbreaks from the movement of these populations.

HIV/AIDS poses a grave impeding risk to the stabilization of peace operations. Integrating testing and treatment for HIV/AIDS in DDR programs is important for maintaining the well-being of male and female ex-combatants, women and girls associated with armed groups, and the greater public health of the civilian community. DDR programs can offer a unique opportunity to reach out to vulnerable groups and intervene in the spread of epidemiological diseases. Practitioners of DDR must co-opt this opportunity and incorporate health programming in their DDR programming.

As with many other diseases, HIV/AIDS prevention can be embedded in DDR through a variety of different outlets. Risk Mapping, based on prevalence, attitudes, vulnerabilities and knowledge, can be facilitated to define the needs of the geo-spatial community. Also, identifying and training HIV/AIDS focal points and developing awareness material and training for target groups can play a role in this type of intervention.  Voluntary counselling, testing and treatment must be available throughout the entire trajectory of the DDR program. Also, ensuring the availability of testing, condoms and post-exposure prophylaxis for ex-combatants is critically important. These types of interventions must be facilitated with existing national HIV prevention and treatment infrastructure, in order to develop and ensure their sustainability.

DDR interventions involving HIV/AIDS have been conducted already in many national initiatives.  In Colombia, joint UN efforts supported the Colombian government in training male and female ex-combatants in sexual and reproductive rights, gender equity, and HIV prevention.  DDR practitioners conducted surveys to determine HIV prevalence and sexual behaviors to tailor HIV-DDR programs to the Colombian caseload. Furthermore, the facilitators provided voluntary counselling and treatment alongside a string of other HIV/AIDS-oriented initiatives.  DDR in Côte d’Ivoire also incorporated a notable HIV/AIDS intervention program. The UN supported the DDR Commission in creating three voluntary counselling and treatment centers, as well as STI treatment infrastructure at all of these sites. These centers were focal points for screening and treatment, and ensured that medical aid would be widely available to all in need. Additionally, through partnerships with the United Nations Operation in Côte d’Ivoire, the commission also trained uniformed personnel on HIV, human rights, gender equity, and technical support on HIV-DDR. They also trained peer educators to provide local training and support for diagnosis of HIV/AIDS and HIV prevention.

Colombia and Côte d’Ivoire are just two successful examples, among many others, of HIV/DDR treatment integration in DDR. However, many challenges exist in the integration of greater medical processes. Lack of human capacity and will is a major component of deficient health resources in DDR programs. Medical diseases such as HIV/AIDS are simply not a priority for DDR practitioners. Especially since the extensive resources needed to prevent and treat epidemiological diseases such as Malaria and HIV may simply not be available in the budget for DDR programs. Additionally, linking DDR health intervention objectives to community health infrastructure may not be possible, as no health infrastructure may exist to begin with in the country of operation. In this case, building the foundations for future health services may be too large of an operation for DDR. Therefore, because of these reasons, health initiatives become secondary and/or far too rudimentary to achieve their primary objective. While implementing health action in DDR programs can be an extensive endeavor, it is undoubtedly necessary to safeguard the most basic aspects of human security in DDR programs.