07/28/2011 11:17 am ET Updated Sep 27, 2011

Dusty Broom Closets in Congo: Rethinking Programming to Combat Sexual Violence

It was a stuffy, windowless broom closet like any other -- replete with empty cardboard boxes, threadbare rags, mops, and of course brooms. The thick layer of dust on two straight-backed wooden chairs facing each other amidst the debris indicated that they had not been sat upon for weeks, maybe months. "This is where we counsel rape victims," said the center manager, a Congolese woman who was thin as a reed and filled with passion. She added, "We do the counseling here because it needs to be confidential." It was a broom closet like any other -- except that it also was supposed to serve as makeshift office for psychotherapy.

I encountered this broom closet-cum-therapist's office on a recent trip to the eastern Democratic Republic of Congo on a visit to a local non-profit's center to assist survivors of sexual violence. We continued the tour. "This is where the survivors stay when they come to us from their villages," the center manager said as she showed me a room with two made up beds. "As you can see, the number of beds is largely insufficient," she went on. But again, judging from the dust that settled over the room to create a stagnant haze, these beds looked like they hadn't had any occupants in them for quite some time.

There is no doubt that sexual violence occurs at astonishing, horrifying levels in the Democratic Republic of Congo, a country that a top United Nations official dubbed the "rape capital of the world" in 2010. The most common narrative employed in Western media is that rape has become a potent, destructive weapon of war used by the country's countless armed groups in their clutches for power and resources. Indeed, just recently, we learned that nearly 250 women said they were raped by soldiers in a few villages over two days in a single province of the country. But some scholars, journalists, and humanitarian aid groups have been problematizing that reductionist version of events, highlighting -- among other things -- that civilians are frequently perpetrators of the violence, that perpetrators also include women, and that victims also include men. Others have pointed out that rape is part of much more widespread, systemic violence in that setting.

If leading media analysts have rightly been calling attention to the way that rape is conceptualized and written about in Congo, I -- as a humanitarian aid worker who has in the past managed programs to combat sexual violence in West Africa -- hope that we can also start to have some serious, constructively critical conversations about the international programs that are being implemented on behalf of rape survivors. After all, Hillary Clinton famously announced in April 2009 that $17 million would be allocated to programs to support survivors of sexual violence in Congo. Today, in villages across the eastern part of the country, local authorities say things like, "Anti-rape programming is in fashion these days." But as I visited dusty broom closet after dusty broom closet, I couldn't help but wonder what was going awry. If sexual violence is so pervasive in Congo, why aren't these centers packed to overflowing?

There are, I believe, some fundamental issues to be resolved concerning programming to support survivors of rape in eastern Congo, not to mention many other emergency settings. Perhaps the most fundamental is the imposition of an Anglo-American understanding of "case management" for these survivors, a concept for which there exists no decent French translation (French being the national language of Congo) and certainly no translation into the country's 200+ local languages. While I agree with a conception of case management in which service providers make various options available to survivors throughout the healing and judicial processes and coordinate service provision over time, all too often it seems that a watered-down notion of case management reaches survivors in a checklist-like set of three services that they must access: medical, legal, and psychosocial. Again, to be very clear, I would not deny that these three types of services should be made available to all survivors of sexual violence. I fear, however, that rather than being made available, they are being presented to them as a pre-packaged set of services that represent the "gold standard" of care and support, even when the services available are of dubious quality and even when survivors themselves might have very different ideas about what they need.

Taking each in turn, medical care seems clearly straightforward: there is generally well accepted international guidance about medical services for rape survivors, and medical care also represents a key service that most survivors hope to receive in the aftermath of violence. (Whether or not services that adequately meet the guidelines are made accessible to survivors is another matter.)

Concerning the legal aspect, however, serious questions remain. The legal services being made available to survivors of rape in Congo link them to a judicial system that is essentially corrupt. Moreover, even some of the organizations promoting legal prosecution of rape perpetrators seemed to have a delicate grasp on notions like confidentiality and core competencies. In one small village, I watched an expatriate worker explain -- in front of a crowd of scores of people -- that rape survivors should do their legal intake interviews only in one specific office, that of a man working for an agricultural non-profit association in the village. Whatever confidentiality might have been ensured in that man's office space was destroyed by this very public proclamation, which already linked that space to services available for survivors of sexual violence. I could also not help but wondering what level of legal advice an untrained agricultural outreach worker would be able to provide to rape survivors.

In a country where pursuing rape prosecution can mean life-threatening reprisals for the victims, efforts to ensure safety and justice for survivors of rape seem ineffective at best. One of the most common complaints I heard from women across eastern Congo was that even men who were successfully prosecuted were able to bribe their way out of jail quickly and cheaply. Surely most survivors want justice, but what are their conceptions of justice? How would it best be attained for them? Approaches to these issues that are much more finely attuned to the local context -- including Congolese women's beliefs about how justice could be served -- and more cognizant of the inefficiencies of the Congolese legal system are clearly needed.

Returning to that dusty broom closet and the "psychosocial support" provided there, it seems clear to me that we have a lot more thinking about ways to ensure that survivors of sexual violence are provided with mental health services that are adapted to their needs. As it stands, a significant amount of the work to support survivors of sexual violence seems to be based on a center-based model that would be roughly equivalent to safe homes in the United States. While one-on-one counseling in such a center might be a useful approach on our shores, the dust on those chairs in that windowless broom closet -- and many others like it that I have encountered in Congo and elsewhere -- indicates to me that some serious thinking remains to be done.

A number of international aid organizations are working through such mental health issues in concerted and thoughtful ways, and there is growing momentum to support initiatives that provide adequate support for women, men, and children in their communities in locally relevant ways. But when I read international humanitarian guidance on appropriate psychosocial support and juxtapose its theory to the reality of underused, ill-adapted shelters mushrooming in a variety of settings, I must pause to wonder why the gap between the two is so wide.

Although the news out of Congo might seem to be a never-ending stream of rape and violence, I do hold out hope that the situation might be slowly improving and that sexual violence will decrease over time. I do expect for us humanitarian actors to engage in some serious soul-searching about the efficacy of our efforts and not hesitate to change our approaches when we see that they are not working.

As I left the center that day in eastern Congo, a woman who was not staying at the center but who liked coming there to pass the time was making purses out of plastic cord on the porch. She had arrived during my tour. "The women who come to our center make these purses to do something with their hands and to make some money," explained the center manager. "Making the purses helps to 'de-traumatize' them." As she spoke, I thought to myself that making purses didn't seem like the most obvious therapeutic service for rape survivors, but then I reminded myself to check my cultural assumptions and to open myself to the possibility that this activity was perhaps very beneficial to the woman.

One kind of support that some shelters in eastern Congo are offering is economic strengthening, which some non-profit workers say is the most frequent request that they receive from women who use their centers. While offering microcredit or small business opportunities to survivors of sexual violence might risk creating a skewed incentive for women to claim having been raped, poverty does seem to be a major preoccupation for much of the Congolese population. Even small-scale poverty alleviation efforts might have major impact, and measures could be developed to ensure that these initiatives are not singling individuals out simply by their status as rape survivors.

The purse-maker certainly seemed intent as she wove cords in and out of each other. When I bought a few purses to take home as gifts to relatives in the United States, the smile that spread across her face as she gave me my change told me that she was doing precisely what she needed to do at that moment in time.