Creating a More Effective Public Health Response to the Effects of Violence, Terror and Instability

The following remarks were presented by Harvard University’s Jocelyn Kelly on February 1, 2012, at a conference hosted by the the War Crimes Research Office and the Women and International Law Program at American University entitled “Addressing Sexual and Gender-Based Violence in Conflict and Post-Conflict Settings: National and International Strategies.”

Good afternoon. My name is Jocelyn Kelly and I’m the Director of the Women in War Program at the Harvard Humanitarian Initiative. I just got back from DRC about 40 hours ago, and it’s such an honor to be here and so extraordinarily inspiring to see this groundswell of interest and support, literally half a world away and a really wonderful opportunity for discussion.

On this last trip I was struck anew at a deep underlying truth of conflict which is this; even modest amounts of violence can create lasting ripple effects, often outside of the area where it happens. And the violence in Congo hasn’t occurred in modest amounts. Two decades of war have seen an exponentiation of violence, fear and insecurity. And no one knows better the effect of even one act of rape, murder or pillage can have on communities than those who are affected. And what they’ve told us is, even modest amounts of violence can affect families, regions and social structures for generations. And while communities know this truth deeply because they’ve lived it, we as programmers, responders, policy makers and academics still struggle; first to understand and second to holistically respond to the problems that destabilized communities face.

I would like to argue today that we should supplement our medical type of models of response to conflict with a public health type of response. So what do I mean by that? I mean in a medical model of response, we very rightly and appropriately focus on responding to pressing individual needs. This type of work should continue and should be expanded. However we also need to bolster this with a public health type of response where we work with communities to address the pernicious effects of war at a population level.

And let me be clear, we do undertake public health-type of interventions in conflict, right? And that’s wells and water and supplementary nutrition and building latrines. But what I’m talking about is, creating a more effective public health response to the effects of violence, terror and instability. And we’re still figuring out how to do that well. That means working at a population level and within social networks to address the malignant effects of what happens to these communities in prolonged conflicts that may last for decades.

In HHIs report, “Hope for the Future Again”, we undertook research with communities throughout the Kivu’s in eastern DRC to better understand the ways that they have been affected by conflict. The title of the report comes from a quote of a young man in Goma who said, “Take all those young men and women who’ve been mentally affected by this war and give them a chance and hope for the future again.” We decided to make it the title because I know it’s very, very easy to get caught up in these shockingly sad tales of what’s going on, but it’s also important to tap into the deep wells of resilience and grace and strength that also exists in these communities. One of the reasons I’m excited to talk about this report right now is because I think it illustrates one of my favorite stories about how we look at sexual violence and conflict, and how challenging it is to understand it.

When I started working in DRC in 2007, we wanted to better understand the effects of sexual violence in conflict on women in DRC. So what more natural than to ask them about sexual violence, and ask women about how it affects them. And, you know, those inquiries were very fruitful but what women told us is we weren’t doing our research right. What we needed to do was talk to men, service providers, community leaders, other women, mothers-in-law, social networks, church groups – to understand how they are affected and respond to sexual violence. We also have to better understand how women exist, not just as people who experience and are victimized by sexual violence, but as powerful agents of change in their own lives.

And so in response to this process what we went out and did was exactly what we were told to do. We talked to service providers and community leaders and men, and did a large round of data collection, qualitative data collection, to better understand on a community level how communities are affected by sexual violence. And I think what I’d like to do here is just outline three main areas of discussion that arose from this research which is; economics, children and community.

Of course, all these topics are related to sexual violence but I think right off the bat you’re already surprised because these are somewhat unrelated, or seem somewhat unrelated at first. It turns out sexual violence and economics are absolutely linked. And it’s challenging for many of us because we come from women’s issues and human rights, and what we do actually need is to understand how economic systems are destabilized by the fear of sexual violence. And that, I think, has continued to be a challenge for us. Sexual violence, and the fear of this type of abuse, create long term destabilizing effects on people’s ability to farm, to work, and to go to market. The recommendations that the communities had around this were that; 1) provide context-appropriate income-generating, not only for women affected by sexual violence but for other vulnerable members of the community, including men. And a lot of times we go in with overly-blunt tools try to do very fine economic analysis. We go in with, you know, 800 sewing machines to try to get an economy going again. But if you train everyone to be a seamstress then no one’s going to need seamstress services, right? So we have to better understand how the economic systems within communities work, and how we as an international community can intervene in appropriate and very tactical ways to help communities rebuild themselves.

Men and women also asked us to encourage community-led implementation of farming and trade cooperatives, including micro-lending. So again, this is something that we are being asked to do a better job of by those who are affected. And finally, to provide security for women who undertake farming and trade. And I know this sounds simple and we think; you know, two decades later, how can we not provide security for women just to go to their fields and do what they need to do every day? And the truth is, we don’t. And one thing I’d like to talk about at the end is a little bit about my latest trip to LRA-affected areas. There was also saw communities that have basically been completely shut down by the sense of insecurity, and so we do need to do a better job of responding to that.

The second theme I’d like to talk about is children. Women worry about their children. It is an essentially important aspect of their lives, and until we as a programming community can help them address this need, they don’t feel like they’re really moving forward. As we all know, children are especially reliant on a myriad of critical social structures: family, religious communities, education systems, health systems, in order to ensure their health and development. And these are the very systems that have been undermined by the war in DRC. Children are affected directly by sexual violence as victims of course, but also indirectly by often having to witness what happens to a family member or secondarily undergo the trauma of having a parent who has been a victim of sexual violence.

One thing that’s really simple that I think we could get right is free education for children. It’s a promise of Kabila’s; it doesn’t exist in DRC, and when you talk to women this is usually their number one issue even if they are experiencing life-threatening medical problems. What they’ll ask first for is education for their children. Create community-run child care centers so safe, supervised spaces for children, especially street children and orphans of which there are many and growing numbers in eastern DRC. And provide child-centered mental health counseling, which is something that we’re really still trying to figure out how to do in many international settings, but we do need to do a better job of, because what we heard over and over again is that there is this generation of young people who’ve grown up in conflict who have known nothing else and who need to understand how to move forward and rebuild their communities and create a new reality.

The wounds resulting from sexual and gender-based violence are multi-dimensional in scope and as we know, often can shatter not only survivor’s lives, but family and community relationships. We talked about the stigmatization and isolation of survivors of sexual violence, the witnessing of public sexual violence in many instances in DRC, and deep lasting changes in social norms because of displacement and lack of cohesion directly resulting from widespread rape.

What do communities ask for in response to these challenges? They’d like us to do a better job of integrating medical, mental health and economic support services. I know how complicated funding is and what a challenge it is to really get everyone together and do integrated responses. But a person is holistic being who doesn’t separate or segregate the services they need and when they need them, and I think we need to continue to understand how to do economic, psychosocial medical care that is integrated. We should offer a family-centered approach to services. I cannot emphasize enough how important this is to women. We tread a very fine line between taking sexual violence as its own extraordinarily important and very unique issue. But responding to sexual violence in a vacuum and looking at women only as victims does them a deep disservice. And sometimes inadvertently, in the way that we provide services, we actually isolate them more and create quite a bit of resentment in their family and their widespread peer network. And so we can find ways to do a better job of this. I think women would be grateful.

The next recommendation from communities is to undertake context-appropriate community reconciliation interventions. There is just often mistrust and, kind of, de-integration of communities. And to find creative ways, whether it’s through peace markets or community fora to bring people back together would be very powerful, and often those interventions are quite cheap. Finally, to improve the reintegration for former combatants. This is very, very important because what we see is often a revolving door where people join armed groups, leave, join again, and are very, very violent within the communities that they come back into because they often simply don’t have the mental health tools to reintegrate.

Just very briefly before I close, I want close I want to say it was interesting for me on a personal level to be in LRA-affected areas, because I’ve worked very closely with Mai-Mai and FDLR-affected communities. And what I was really struck by was: 1) How sexual violence and abduction of children really changed the way that communities existed and in many places in DRC there’s ghost towns. Just empty structures where the roofs have fallen in and no one’s around and there’s no food. Right? Something as simple as sexual violence being linked to actually the most basic human need, which is food. And we’re still figuring out how to respond in northern DRC and these LRA-affected areas, but what’s really intriguing is that there’s this very close link to sexual violence and simply not being able to farm and create the food that communities need to move forward. And so there’s an enormous amount of displacement.

We see certain scourges that existed in the Kivu also in these northern areas. So, very short funding cycles, disintegrated programming, and a lack of understanding of the community needs. What I’d like to argue for is the importance of recognizing the co-morbidities of problems, and to recognizing that sexual violence also exists within this wide set of needs that are created because of the instability created by sexual violence, but that the needs are often a bit outside of the scope of what we think of. And I think to learn from the past, so to take lessons from what we’ve seen in the Kivu’s with the violence there, and to apply it to better responding in places like the north which are very currently affected by the LRA.

So I’ll just close by saying that, while the picture we paint in DRC is often very, very bleak we should also recognize that this is a time of rebuilding. And any time that you rebuild you have an extraordinary opportunity to change things. And so for each problem of tearing apart strong social fabric and the destruction of economic and social systems, we see the potential to help communities generate better solutions to move forward in the future. And this means recognizing women, not only as victims of sexual violence, but as leaders and economic drivers. Vital actors in their communities and experts in the way that they would like to rebuild the communities in which they live.


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