July 28, 2021

the Mukwege model duplicated in the Central African Republic

Zenaba has the absent look of resigned women. His life came to an end on May 5, 2018 in the PK5 district of Bangui, the Central African capital. That day, rebels from the anti-balaka militias behead his 30-year-old son in front of his eyes and shoot the 25-year-old at close range. “Without my children, I am nothing. I went to see their executioners to ask that they kill me, their leader knocked me down and seven men raped and beat me ”, this 52-year-old woman calmly recounts.

The NGO Médecins sans frontières (MSF) provided her with emergency care and then referred her to the Association des femmes juristes de Centrafrique (AFJC), a structure created in 1991 to provide legal and psychological support to victims of sexual or domestic violence. “I thought I was going crazy. Fortunately, I received help from the association. “ His case has been awaiting judgment before the Special Criminal Court since December 2020. His executioners are still at large.

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Today, there are about fifteen of them waiting their turn under the porch of the AFJC. “Speech has freed up in recent years, also among men. Even if victims of sexual abuse are still very often stigmatized ”, explains Rosalie Kobo, the general secretary. In recent months, the flow of visitors has increased. “As soon as armed conflicts resume, as at the end of 2020 with the approach of the presidential election, more victims of sexual violence knock on our door. ” Lawyers, jurists and volunteers struggle to handle all cases. Especially since the association aims to take charge of all gender-based violence (GBV), also including physical and psychological attacks, forced marriages, domestic violence and denial of resources.

Skills transfer

Since September 2020, they have been supported by experts from the neighboring Democratic Republic of Congo (DRC), sent as part of an international project called Nengo, “dignity” in the Sango language. Its objective: to create a center for the holistic care of victims on the model of the Panzi hospital, in Bukavu (DRC), an establishment founded in 1999 by Doctor Denis Mukwege, awarded the 2018 Nobel Peace Prize for his working with women who have been sexually abused. In the clinic of the famous gynecologist, the survivors are taken care of medically, surgically, psychologically and supported on the legal and socio-economic level.

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To replicate this proven model in the Central African Republic, the Nengo project relies on existing institutions: the Association of Women Lawyers and the Friendship Hospital. Two “entry doors” for the victims. “The two entities are in permanent communication and a single point of contact, the psychosocial agent, follows their file throughout the course”, explains Jacqueline Uwimana, the coordinator of the Nengo project. This is the principle of the “one-stop-shop” created by Dr Mukwege: “We have chosen not to create a new structure. We believe that Central African professionals know the field better than anyone. Our objective is to improve what exists, with funding and by transferring skills. ”

Four Congolese experts – a gynecologist, a psychologist, a psychosocial agent and a lawyer -, all disciples of Mukwege, were therefore sent in September 2020 for a four-year mission. A consortium, made up of the Pierre Fabre Foundation, the Denis Mukwege Foundation, the Francophone Institute for Justice and Democracy as well as the Panzi Foundation, is piloting this South-South transfer of skills, with the financial support of the French Development Agency (AFD). In total, an investment of 5.4 million euros.

Give back their dignity to women

Doctor Roch Mbetid has been waiting for this funding since 2013. At the time, the country again plunges into a bloody crisis and rape is used as an inexpensive weapon of war. The Friendship Hospital, where he works as an obstetrician-gynecologist, receives more and more women victims of sexual abuse. “One day, I saw a mother arrive and her two daughters, 19 and 9 years old. All three had been raped by Seleka rebels; the two sisters infected with HIV and the older one was pregnant. I understood that our role was going to evolve towards more support for sexual violence ”, he testifies.

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At first, he financed the costs of drugs and medical examinations with his own money. But quickly, the dilapidated state of the facilities, the lack of equipment and the absence of doctors trained in gynecological reconstruction techniques reduced its ambitions. “I was following Dr Mukwege’s fight closely. I contacted his foundation in 2017 to help us. This is how the project was born Nengo. »

It is to restore their dignity to women that Dr. Dieudonné Boengandi learned to repair their genitals alongside the Nobel Prize. This Congolese gynecologist spent seven years at the Panzi hospital (DRC). This Tuesday, in the operating theater of the Friendship hospital, he is the conductor of operations. A doctor and four interns carefully follow his instructions. The operation of the day is a fistula, a perforation of the wall between the bladder and the vagina, the consequence of a complicated childbirth. Because the Nengo project is not limited to taking care of victims of sexual violence. “We operate on women who have gynecological damage due to excision, but also to childbirth”, explains the Congolese doctor.

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In this central African country, childbirth, very often performed at home, can turn out to be violent. Suzanne endured the consequences for three decades. “At birth, my baby looked bad, we had to force it to pass and I was destroyed”, recounts this 56-year-old mother, operated on by Doctor Boengandi for a vesicovaginal fistula. I lived thirty years permanently wet with my urine. No one wanted to approach me in the village anymore. “

Listening, support and reintegration

Until a few months ago, this intervention would not have been possible. “Thanks to the expertise of the Panzi Foundation doctors, our staff has become more technical and we are able to operate on more complicated cases”, welcomes Professor Serdouma, head of the gynecology-obstetrics department, who is impatiently awaiting a second operating theater to perform up to three operations per day. In all, 1.6 million euros, or 30% of the budget of the Nengo project, will be allocated to the rehabilitation of the service, the purchase of medical equipment, the construction of a reception house for the survivors and medical acts, completely free for beneficiaries.

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At the center of the service is the office of psychosocial agents (APS). Rosette Sipa is the Congolese referent of the project. Since 2004, she has been experimenting with listening and support techniques at Panzi hospital. APS is the linchpin of Dr Mukwege’s “one-stop-shop” model. “A good welcome ensures healing, highlighted Sipa Rosette. The victim often arrives in despair because they are rejected by their community. We help him to express himself, we use the techniques of neurofeedback [méthode de maîtrise de l’activité cérébrale] and sometimes accompany him in his community to help his reintegration. “

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It is the psychosocial agent who will assess whether the victim needs psychological, socio-economic, legal or legal assistance. In these latter cases, it will be oriented towards the service of Mr.e Yvette Kabuo, who deals with both civil and criminal matters. “The Central African legal arsenal is quite satisfactory, but there is a major problem of procedural slowness, regrets the lawyer, who for ten years oversaw the legal pillar of the Panzi Foundation. We must support jurists and lawyers so that more cases are heard. ”

Women come to the AFJC, the Association of Women Lawyers of the Central African Republic, to testify about the gender violence they have suffered.

With his small team, Me Kabuo has filed 66 cases relating to gender-based violence in Central African courts since January. Its mission: to stop impunity. “If the culprits are not punished, we will not be able to break the cycle of violence that is firmly entrenched in the culture after years of war,” deplores Jacqueline Uwimana, the project coordinator. And impunity does not encourage victims to file complaints. “

Ecosystem with associations

A challenge in addition to that of financing the project, signed for a period of four years. At the end of this period, how will the victims be able to seek treatment when the operation for a fistula is estimated at 262,000 CFA francs (400 euros), or more than eleven times the average monthly income (23,000 CFA francs, according to the World Bank)? Can they always be assisted by a lawyer? “We are responsible for supporting the program over the long term”, recognizes Denis Vasseur, AFD director in Bangui.

To be sustainable, Nengo must be anchored in the Central African landscape by linking partnerships with local NGOs. “We want to create an ecosystem with reintegration associations and strengthen our relationship with MSF which repatriates victims from the hinterland where we are not present”, explains Jacqueline Uwimana.

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Since the resumption of fighting between rebel groups of the Coalition of Patriots for Change (CPC) and government forces (FACA) at the end of 2020, MSF has seen a significant increase in cases of sexual violence, from 173 consultations in December. 2020 to 421 in March in its Bangui center. Same observation of the Nengo team, three rapes out of four referenced since the start of the project are linked to the conflict. Among them, victims of older periods, such as Zenaba, who is waiting for justice to be done to start a new life in Cameroon.

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This article is produced as part of a partnership with the French Development Agency

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