Physicians for Human Rights and the Harvard Humanitarian Initiative (PHR/HHI) set out to conduct a systematic assessment of sexual assault and other human rights violations suffered by Darfuri women who had been subjected to sexual violence in the course of attacks on their villages in Darfur and forced flight to camps on the Chad/Sudan border. The effort was part of a continued commitment to assuring that crimes against humanity, including sexual assault, be documented and exposed, and their mental, physical and social consequences understood so that increased protection, prevention, healing and comprehensive justice can be delivered to the survivors. The PHR/HHI study was conducted in Chad as security conditions precluded such an assessment in Sudan.
Rape in Darfur has been documented by the United Nations, by human rights organizations, and by the International Criminal Court. The United Nations International Commission of Inquiry, whose findings led to the referral of the Darfur situation to the International Criminal Court, found that rape and sexual violence had been used by the Sudanese Army and Janjaweed as "a deliberate strategy with the aim of terrorizing the population, ensuring control of the movement of the IDP population and perpetuating its displacement."(1) Sexual violence has also been reported in and around the camps in Chad in recent years.(2)
Few studies have looked at the effects of such war-related sexual violence or documented how resulting trauma is exacerbated by current conditions of life. PHR and HHI have worked extensively over the past 15 years, and in preparation for this study to develop methods to document this "silent crime" and its consequences in a safe and respectful manner. PHR/HHI undertook to overcome the obstacles inherent in such research and developed a plan to interview survivors of sexual assault in refugee camps in Chad and to corroborate accounts of assault with evaluations by clinical experts.
Limited in its access to all refugee camps due to security and logistical constraints, the team of four field researchers from PHR and HHI conducted in-depth interviews with 88 women in one refugee camp. As they were concerned about the risk for women who report sexual violence in this context and were restricted in the framework of questioning by the guidelines and regulations of camp officials, the researchers did not specifically seek out women exposed to such violence, but instead asked any women interested in being interviewed to discuss their health and lives in the camps. In order to assess the reliability of allegations of rape and physical assault, medical and psychological evaluations were conducted on a subset of 21 individuals. These evaluations were carried out according to international medico-legal standards to assess the extent to which physical and psychological evidence corroborated testimonial accounts.
Although the sampling methods do not permit generalizations to larger populations, the 88 cases demonstrate the effects of crimes against these women and their communities in the form of systematic attacks characterized by murder, rape, looting, destruction and burning of property, and forced displacement in Darfur, but also in Chad where sexual assaults are perpetrated with utter impunity. The nightmare therefore continues in refugee camps in Chad through the constant threat of rape (when women forage for firewood to cook their food), chronic hunger, and a lack of essential needs to support their families. Many of the women expressed the feeling that they would be better off anywhere else and even, some said, better off dead. The report provides recommendations which aim to prevent further assaults on women, meet their current needs for support in the camp, and provide a foundation for the safe return of women and their families to Darfur to begin the lifetime challenge of rebuilding their lives.
The women interviewed in the Farchana Camp in eastern Chad are but a few of the millions whose lives have been indelibly altered by the crisis which erupted in Sudan's Darfur region in 2003. In April of that year, the Sudanese Armed Forces and the Janjaweed, the proxy militias that they armed and funded, responded to an attack on military and police installations in the North Darfur town of El Fasher by systematically bombing, then burning and looting thousands of villages in Darfur, killing men, raping women and looting livestock. The attackers chased villagers out into the desert where temperatures regularly top 115 degrees Fahrenheit and there is little potable water or food.(3) The conflict has left between 200,000 and 400,000(4) dead of violent injuries, starvation or disease, and has displaced nearly three million people; 2.7 million are displaced within Darfur itself and over another 268,500 refugees in eastern Chad. Nearly 3.5 million people are dependent on the international community for food aid as a result of this conflict.(5)
The Farchana Camp
UNHCR established the Farchana Camp in January 2004 to house 2,000 Darfuri refugees(6) fleeing violence across the border 55 kilometers away. In November 2008, the population of Farchana was 20,650, with 5,643 families.(7) Movement into and out of the camp is fluid, with refugees leaving the camp regularly to collect firewood, graze animals or go to the market several miles from the camp and on the outskirts of Farchana village. At the time of the PHR/HHI investigation, approximately 2,000 Chadian soldiers were present around the Farchana camp and team members saw several dozen armed soldiers inside the camp.
As of November 2008, there were three doctors to care for the 20,000 refugees in Farchana Camp and the villagers from Farchana who come to the camp to seek medical care. Many women must obtain permission from their husbands to receive any services at the clinic. In spite of provisions of a limited supply of firewood by one NGO, many women must still make the dangerous and often lengthy journey outside the camp to gather fuel for cooking from scarce firewood and brush.
A team comprised of three physicians (an internist, a urogynecologist, and a psychiatrist) and a human rights researcher used quantitative and qualitative data from a non-probability sample of 88 women refugees in the Farchana Camp. The field investigation consisted of a questionnaire with 42 questions about the respondent's life in Darfur, the events that caused her to leave Darfur, her life in Chad and her self-reported health status. Clinicians also conducted physical and psychological evaluations of 21 of the women who had reported physical or sexual assault. These evaluations were based on the Manual on Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (also known as the "Istanbul Protocol" or "IP").(8) Interviews were conducted in Arabic or Masalit, with interpreters who were trained for two days by the team.
To protect their safety and privacy, the team did not ask for respondents' names or record their interviews. The average age of interviewees was 35 years with a median age of 30 years and an age range of 18 to 75 years. Almost half (43%) of the interviewees did not have a husband living with them in the camp.
While this sampling method does not permit the generalization of study findings to women in Darfur or those living in Farchana Camp, it nonetheless provides broad insights into the experiences and suffering of a larger group. Additional information was derived from interviews with a wide range of stakeholders internationally and in the region.
Rapes in Darfur and Chad
In Darfur and Chad, a total of 20 confirmed rapes were perpetrated against 17 of the 88 women interviewed, with one woman suffering two assaults in Chad and two women suffering an assault each in Darfur and Chad. An additional 12 instances were considered highly probable by the interviewers. This assessment was based on behaviors and verbal responses to signaling interview questions that were designed to allow expert interviewers to deem a sexual assault likely. Eight of the 88 respondents had witnessed sexual assaults and 30 respondents stated that they were aware of rape incidents occurring in either Darfur (16 respondents) or Chad (14 respondents). For 19 of the women, the interview was the first time they had discussed the sexual assault with anyone.
In each case of rape, Istanbul Protocol-based medical evaluations provided physical and psychological evidence that was highly consistent with women's specific allegations of rape and other physical abuse. There were no cases in which allegations were either unsupported or inconsistent with the physical and/or psyhcological evidence observed. These clinical evaluations indicate a very high level of reliability of allegations of rape among the overall sample of women in the PHR/HHI study. The Istanbul Protocol-based medical evaluations not only corroborate women's accounts of rape and other crimes against humanity that they have experienced in Darfur, but accounts of rape and ongoing deprivations of basic needs in refugee camps in Chad.
Of the 32 instances of confirmed and highly probable rape, 17 occurred in Darfur (17 of the 88 respondents). Of these, nine were confirmed rapes and the majority of them (7) were gang rapes. Additionally five women reported that they had witnessed gang rape in Darfur. Three of the nine confirmed rapes resulted in pregnancies. Of these pregnancies there were two live births and one miscarriage. One rape was described as being committed in the presence of family members. The narratives indicate that rapists frequently beat women with guns and/or attacked them with knives before or during the rape. One woman described being raped during the attack on her village. She was 13 at the time:
"One of the Janjaweed pushed me to the ground. He forced my clothes off and they raped me one by one vaginally. No objects were inserted. When they shot my father, they saw I was a little girl. I did not have any energy or force against them. They used me. I started bleeding. It was so painful. I could not stand up ... I was sick for seven days. No one helped me ..."
After being raped, women reported excessive bleeding, not being able to walk well, and general body aches.
Respondents described similar patterns and characteristics of methods and behaviors by perpetrators during the attacks in Darfur. Assailants were typically described as fair-skinned and wearing green or khaki uniforms with head wraps. Interviewees noted that the assailants often spoke Arabic and rode horses or camels. The village was usually surrounded by a large number of perpetrators and attacks often occurred in the early morning. Concurrent air strikes were another common feature.
"There were many - [unable to quantify] - followed by Sudanese in planes and horses wearing official Sudanese army clothes. They entered into the village and were shooting and people started running. Those that remained were rounded up and made to lie down. They covered them with wood and branches, and set the wood on fire. Sixty-five died that day."
Darfuri women were sometimes called "slaves" by their assailants and Darfuri males were targeted to be killed. Assailants typically burned their villages and confiscated their livestock.
"We were in the pasture with our animals and we saw the Arabs coming and they shot my brother and my husband and they took all our animals. We couldn't do anything...."
Many of the women reported that family members were killed during the attacks on their village. Some witnessed the shooting or beating of close family members including husbands, fathers, brothers and cousins.
Few women said that they reported either the rape they had suffered or the attacks on their villages because, they said, the attacks were committed by the government itself. They declared that this fact left them without any options for reporting the crimes.
Physical Injury Experienced in Darfur
One-third of the respondents suffered direct physical harm as a result of the attack on their villages in Darfur. Women reported acute symptoms including pain, swelling, bleeding, bruising, lacerations, difficulty walking, and loss of consciousness; rape victims reported vaginal bleeding, discharge and pelvic pain. Chronic complaints included headaches, hip pain and chronic pelvic inflammatory disease. Few women had sought and received medical attention from a doctor, clinic, hospital or traditional healer and few had been evaluated for sexually transmitted diseases or HIV.
When asked to describe their lives in Darfur, most women said that they were farmers who grew a variety of crops and also owned animals. While their descriptions of wealth differed (in the amount of animals owned or land owned), most women stated that they had had everything they needed in Darfur and that life was good there.
Sexual and Other Physical Violence in and Around Camps in Chad
Of the 32 instances of confirmed and highly probable rape, 15 occurred in Chad, with one woman assaulted twice there. Of these, eleven were confirmed rapes and four were highly probable rapes. Of the eleven confirmed rapes, eight were reported to have resulted in a pregnancy. There was one confirmed gang rape. The majority of confirmed rapes (10/11) occurred when women left the camps in search of firewood or to pasture their livestock. Respondents identified the rapists as Chadian soldiers and civilians. While NGOs acknowledge that rape and sexual assault of refugee women in camps is occurring, it is likely that the extent of the problem is substantially underreported due to stigma and repercussions following divulgence of a sexual assault.
One woman related,
"I went out alone to bring my animals to pasture. A man came up to me and threatened me with his gun. Then he did everything he liked."
The incident occurred approximately nine months prior and the respondent was pregnant.
One quarter of the respondents reported suffering physical harm since living as refugees in Chad. One respondent stated,
"The first year I was here, two men beat me when I went to collect wood. They beat me on my arm and head with wood. Six of us were there. They beat two of us. I told my mother and father, and we reported it to the president of the camp, but nothing was ever done."
Fear, Insecurity and Impunity in Chad Camps
The lack of safety and the ongoing fear of sexual violence were a concern of virtually half (46%) of the women interviewed in the Farchana Camp. As one lamented,
"This is not my country. We get raped when we leave the camp. In my village, we could do what we wanted and there was enough food. I want to go back to my village, but it's still not safe."
Women reported a general insecurity and unhappiness about life in the camp. Many reported being terrified of going out of the camp to graze animals or collect wood for fear of being beaten or raped. Women noted that though they had reported assaults to camp authorities, there was no response. Some feared that their families would find out if they reported the rapes. Women said that they preferred to suffer in silence rather than risk repercussions.
A strong majority of the women interviewed, nearly 60%, reported insufficient food as a problem. Many said they were always hungry; that the diet and quantities of food were inadequate and that rations were continuing to be cut. Food rations consisted of 2,100 calories in the form of sorghum, oil, salt, sugar and a corn-soy blend. corn-soy blend, oil, salt and sugar.(9) Refugees had to pay or give a portion of their ration to have the sorghum ground, and many sold their sorghum rations for milk or meat, thereby diminishing their total caloric intake.
Physical and Mental Health
Researchers asked women to rate their physical and mental health status in Darfur and now in Chad on a 1-5 scale with 1 being "very good" and 5 being "poor." Women reported a marked deterioration in their physical health status since leaving Darfur, with an average ranking of 3.99 for health in Chad versus 2.06 for Darfur. The Istanbul Protocol medical evaluations indicated that women experienced multiple acute and chronic physical symptoms and disabilities. Acute symptoms included pain, swelling, bleeding, bruising, lacerations, difficulty walking, and loss of consciousness. Those who were raped also reported vaginal bleeding, discharge and pelvic pain. Some went on to develop scars which were consistent with allegations of injury or bony deformities from fractured bones that were documented by visual inspection by the clinical evaluators.
The study indicated a marked deterioration in self-reported mental health, where the average score in Chad was 4.90. "I am sad every day (since leaving Darfur). I feel not well in my skin," explained one respondent. Few women felt comfortable using the mental health services in the camp. One refugee, who herself had been trained as a counselor had not told anyone that she had been raped at knifepoint in Chad. Other women said that they felt ashamed and did not want to tell anyone about the violation. Women who experienced rape (confirmed or highly probable) were three times more likely to report suicidal thoughts than were women who did not report sexual violence.
"I am very sad, especially when I am alone."
"How can I feel happy? They raped me. They killed my family. They raped me here."
She reported marked sleep disturbances and frequent nightmares about "what happened." She also experienced frequent exaggerated startle reactions and constant hypervigilence:
"I always think someone is following me and wants to rape me. It is better to die."
Of the 21 women examined on the basis of the Istanbul Protocol, all 21 women experienced one or more of the following conditions, Major Depressive Disorder (MDD), Depressive Disorder Not Otherwise Specified (DD-NOS),(10) Post Traumatic Stress Disorder (PTSD), or some symptoms of PTSD. Nineteen of the 21 (90%) women interviewed demonstrated diagnostic criteria for MDD (15/21, 71%) or DD-NOS (4/21, 19%). In addition, diagnostic criteria for PTSD or some symptoms of PTSD were noted in 16 (76%) of the women. Women commonly reported feelings of persistent hypervigilance and a state of being easily startled, routine sleep disturbances, generalized feelings of sadness and dysphoria, decreased energy and generalized feelings of weakness and anhedonia, and recurrent flashbacks of the attacks in Darfur and murdered relatives.
Social Stigma/Physical Repercussions
Rapes resulting in pregnancies carried significant physical and social consequences, particularly for familial and communal relationships. Women with confirmed rapes were six times more likely to be divorced or separated than those who were not raped and some women described community rejection and physical violence by family members. One woman stated,
"After the man raped me, they (my family) would not eat with me. They treated me like a dog and I had to eat alone."
The Camps in Chad
The PHR/HHI investigators found that after five years, the Darfuris living in the camps are reaching a "tipping point" of physical misery, depression, and dissatisfaction in the camps. This is due to a variety of reasons, including the lack of physical security outside the camps, insufficient food rations, a yearning to return home and a lack of opportunities for adults to earn money.
The twelve refugee camps in Chad are 'federalized', with different NGOs providing services in different camps. As the lead agency, UNHCR attempts to set minimum standards in health services and psycho-social services. However, based on the research team's conversations with UN staff familiar with camp operations in Chad, there appears to be difficulty in standardizing mental health services.
Due to the physical insecurity and environmental extremes, eastern Chad is an extremely difficult place in which to work. This leads to high staff turnover and difficulty finding qualified staff which in turn creates tremendous challenges to provision of high-quality services, including psycho-social support.
Longing to Return
A majority of the women interviewed expressed a strong desire to return to their villages in Darfur. They dream of the comfortable, secure routines of their past lives in Darfur before the attacks.
Farchana Women Protest for Dignity and Rights
Following an incident on June 5, 2008 where seven women accused of prostitution for working outside the camp were tied-up, whipped, and beaten with sticks of firewood by camp residents, a group of eight Darfuri women reacted by writing a one-page document in Arabic. They appealed for their rights and for recognition by the outside world of the plight of women refugees in Chad. The document made its way to PHR, which published it as the Farchana Manifesto. It calls for freedom of expression, movement, property ownership, the right to education and opportunity for employment, the right to determine age of marriage and to be free from violence and exploitation. The document is included in this report, with more details presented at Darfuriwomen.org.
Insecurity and Perpetual Vulnerability for Refugee Women
Darfuri women fled a war and yet have not found safety in Chad. They are compelled by the basic need of survival to leave the camp to obtain the fuel to cook food for their families, and in doing so, risk being raped and subsequently rejected and ostracized by their husbands and families. The war crimes of killings, destruction of livelihoods and forced expulsion from Darfur have also left them in a state of perpetual vulnerability and need for the most basic elements of human survival. The violence that occurred in Darfur persists as a terrible memory but what most concerns the women interviewed in the Farchana Camp is the oppressive environment of insecurity they must endure on a daily basis.
Heavy Psychological Burden: Women Feel Trapped
The cumulative emotional experience of previous attacks is now combined with the impact of current insecurity and ongoing fear of new assaults. Women express lack of trust in camp leadership, a sense of being trapped in a place that is not safe, and fear of speaking out lest they risk retaliation. This heavy psychological burden shows up in the high levels of depression and anxiety expressed in interviews and may explain their described deterioration in general health and constrained use of other services. The study revealed a general innate feeling of hopelessness in living under current camp conditions. The psychological consequences of such experiences are likely to have a marked, adverse impact on women's overall health and well-being, their family and social interaction, and potentially their capacity to work in the future if their time in Chad continues to be prolonged. In addition, the stigma of having been raped will likely have significant discriminatory effects for the women and their families and consequently exacerbate and prolong their psychological symptoms and disabilities in part because disclosure is so taboo.
Failure to Institute Adequate Protection in Chad Refugee Camp
The results of this study indicate that the protection regime built by international, national and local authorities still has many gaps and insufficiencies for women in the camps. The women report that along with Chadian civilians, Chadian soldiers are among the assailants; they are allowed to come into the camp and evidently are insufficiently trained in their protection obligations.
Absence of Accountability Mechanisms
The absence of accountability mechanisms of any efficacy - reporting channels, investigations, arrests, or trials - reinforced the prevailing sense of marginalization and insecurity expressed by these women. Not only were they under constant threat as they saw the situation, but no one seemed to care.
Lack of Legal Recourse
Darfuri survivors of rape and other sexual violence have little to no legal recourse in either Chad or Sudan. Chad has international treaty-based legal obligations to protect women from sexual and gender-based violence including through its ratifications of the International Covenant on Civil and Political Rights (ICCPR), the African Charter, and the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW).(11)
Moreover, under the 1951 Refugee Convention, which Chad has also ratified, refugees must be given all legal recourse extended to Chadian citizens.(12) Unfortunately, the lack of meaningful enforcement of the rule of law and the absence of an independent and functioning judiciary in Chad hamper any recourse that may in theory be extended to refugees under Chadian law.
Chad's Penal Code governs punishment for rape and gross indecency.(13) But Chadian law criminalizing rape and sexual violence suffers from serious deficiencies. Human rights advocates report that necessary implementing decrees (décrets d'application) for laws protecting women from violence have not been promulgated. In addition, traditional tribal courts which apply customary law often hold sway in rural areas such as in eastern Chad.(14)
Serious structural problems with Chad's justice system also result in a judiciary that is widely reported to be ineffective, weak, and suffers from a profound lack of public trust.15 A recent initiative to bring mobile courts to eastern Chad has been hampered by insecurity and lack of political will.
Failure to Protect
Among UN agencies, the United Nations High Commissioner for Refugees (UNHCR) has the lead responsibility for the well-being of refugees in Chad largely through its operational and implementing partners. As UNHCR has recognized, important aspects of protection include ensuring the safety and well-being of refugees in countries of asylum; meeting the needs of refugees including, in particular, the special needs of victims of violence, and especially women who are single heads of household; ensuring the prompt investigation of allegations of sexual abuse and exploitation; enhancing women's meaningful participation in decision-making processes related to refugee protection; empowering women so that there is equitable camp governance; ensuring accessible and confidential complaint and redress mechanisms for victims of sexual abuse; and ensuring the existence of adequate remedial measures for victims of such abuse. Unfortunately, this study reveals that refugees in Chad suffer from woefully inadequate protection from rape and other forms of sexual and gender-based violence.
The Chadian government has, with the assistance of the UN, begun to take a more prominent role in attempting to provide protection to women and girls living in refugee camps. It is hoped that a new specialized Chadian police force, bolstered by the UN Mission in the Central African Republic and Chad (MINURCAT), will increase protections for refugees in eastern Chad. There is concern, however, that the low numbers of the force and the magnitude of the security vacuum mean that it is unlikely to have an immediate or significant change in the lives of women and girls. As to reports of rape of refugee women by Chadian army soldiers, crimes committed by members of the military are supposed to be tried in military court; as of February 2009 such courts had not been established.16 Local authorities and refugee camp leaders also appear to be in a state of formal denial, as one local Chadian official indicated:
"It is our responsibility to protect these refugees, and I can tell you that there is not rape happening here-it's all consensual."
The PHR/HHI study of the women interviewed in Farchana identified three major areas in which important measures could be taken to improve the lives of the women affected by sexual violence and displacement
1. Prevention and Protection;
2. Justice and Accountability; and
3. Support to Survivors.
Above all, the refugees should be allowed to return home i