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Walking the long, airy gynecological surgery ward of Panzi Hospital a few days ago, Denis Mukwege saw a face he recognized. He had treated this woman before, five years earlier.

"And now she is back again," he recalled a couple of hours later, his voice leaden with despair. "She was raped again at the beginning of this year, and now she's completely destroyed again."

Dr. Mukwege is a Congolese doctor who repairs the injuries of the legions of women gang-raped as a tactic in the country's 12-year-old war. He is a determinedly optimistic healer, a man who spends his day facing the worst of what humans do and yet still laughs often in a booming baritone.

But this was enough - nearly - to sap his will to carry on.

The young woman greeted him with the love and warmth that all the patients at Panzi have for him, but she had grim news to pass on. She told Dr. Mukwege about a friend she had made during her first stay at the hospital five years before, a young woman whose genitals had also been mutilated and who took a long time to heal. But eventually, that girl too returned home, to a village in southeastern Congo. Last year she was abducted again, this time by the Interahamwe, the remnants of the Rwandan rebel group which carried out that country's genocide in 1994 and then fled into the jungles of Congo.

The militia took her to their forest camp and used her constantly for sex for nine months, until she got pregnant, at which point they released her. She returned to her village mutilated and acutely malnourished - and because of her wounds and her weakness, died in childbirth a few weeks ago.

"She was so happy to get treated - she was really very happy," Dr. Mukwege recalled of her hospital stay. The girl's name was Sibazuri; it means "people are not kind" in Kiswahili. "This Sibazuri, we won't see her again," he added, almost to himself, his huge hands rubbing slowly back and forth across his knees. "What did she do worse than anyone else?"

That morning conversation in the ward had shaken him badly. "I ask myself, 'Why should I continue with this work? I have treated 21,000 rape victims. Will all of these women end up in the same situation?' "

Ostensibly, Congo is a nation at peace, but the truth is that the war in the mineral-rich east, long an economic lure to the country's neighbours, never went away. A 10-month-old peace process specifically aimed at the east began to founder in late August, likely because the 23 armed groups involved saw they risked losing control of Congo's lucrative illegal-minerals trade. Open fighting began six weeks ago, and with it, a new spike in public gang rapes and sexual enslavements.

"The numbers were steadily going down - I'm talking of new cases, we always continued to get women who had been injured two or three or four years before ...," Dr. Mukwege said. "But since Aug. 28, they are going up again. Now we have new cases arriving, of women raped this week."

The return to fighting, and the swell in women arriving bloody and desperate, has demoralized his staff. "We think, 'Why go on? Why work for people who are going to kill each other?' " he asked. "I would not be discouraged with this work if the problem will end - but if you can't see the end. ..."

To round it off, Dr. Mukwege returned from Europe, where he lobbied governments there to do more to end the fighting in eastern Congo, much of it funded by neighbouring countries. Many people, including playwright Eve Ensler, creator of The Vagina Monologues , have been lobbying for Congo's women in recent years. Yet when Dr. Mukwege spoke in Europe, many of the politicians looked at him blankly, he said, saying they had no idea there was still fighting in Congo, no idea the region was the site of the most brutal abuse of women in the world.

That nearly finished him.

"We've been everywhere, we've talked to everyone, but we see no change ...," he said. "I decided I should go back to my village maternelle and raise chickens."

He was joking, mostly. Unfailingly modest, he also knows he is the most powerful advocate Congolese women have. He strides through the hospital's outdoor walkways in a white coat, white pants, white shoes, the only colour a bright red-and-green badge that reads "Stop Raping Our Greatest Resources, Power to the Women and Girls of the Democratic Republic of Congo."

Ms. Ensler calls him a "complete hero;" to the patients he treats, he is one step short of God, a God who flirts and teases and cajoles. Mateso Nabutonzi, 25, was awaiting her third round of surgery last week. She made it to Panzi after living for five years with horrific vaginal fistula she suffered after being sexually enslaved by a militia. "I know I'll be healed, maybe one day," she said, "And I thank Dr. Mukwege. I'm fed here and someone looks after me, and because of him I sleep safely."

The doctor, 53, is the third of nine children of a gentle Pentecostal minister and his wife. As a boy he travelled with his father to pray for the sick, but soon decided that wasn't enough, that God had given him the ability to do more to help people than simply pray for them. He studied medicine and was working in a rural hospital when he noticed the stream of women arriving with hideous complications of childbirth because they had no access to obstetric services. So he headed to France for specialized training in gynecology, and then promptly returned to the bush hospital.

But it was destroyed at the start of the war, and he moved to Bukavu. Here, too, there were streams of women arriving at the point of death from obstructed labour, so he and colleagues set out to build Panzi Hospital. His original vision was a maternity ward with surgical capabilities, but from the start, survivors of sexual violence arrived seeking help - sometimes naked, often bleeding, almost always leaking urine and feces from their torn vaginas. Soon rape survivors filled 250 of 350 beds. Thus Dr. Mukwege, then the only gynecologist in a province of 65,000 square kilometres, developed his grim expertise. He is likely the world's leading expert on repairing injuries of rape.

And yet he determinedly eschews any sort of recognition.

"I get more from these women than I give them, these women, blessées dans leur intimités. When I see them smile, when they come up to me and say, ' Papa, ça va,' I wonder, 'What have I done to be in good health, to be well?' "

Dr. Mukwege is a married father of five, but feels constantly torn from his family, putting in 18-hour days at the hospital. While in the past few years he has trained a new cadre of young doctors to repair fistula, he still does up to 10 surgeries a day himself.

Organizations such as Ms. Ensler's V-Day also call him away from Panzi to try to raise awareness about the epidemic of rape, and he is diplomatic if blunt about the lack of intervention to end it.

"The problem is known, but the government is inaudible," he said. "We would have liked to have seen a much stronger engagement by the government. It doesn't need money to condemn the rape - they would need only a microphone and the will."

While he waits for an effort - Congolese and international - to help end the violence, Dr. Mukwege goes on trying to restore its victims, and he is constantly awed by them. "They have no reason to be happy, but they have a certain strength, and I don't have it - not their strength or their joy."



A horrific tactic seen again and again

During wars and most forms of civil conflict throughout history, women and children have been targeted for rape and sexual violence, a tactic intended to destabilize and dehumanize the enemy.

Some of the most brutal violence against women was documented in the early part of the 20th century: the rape of Nanking, the Nazi genocide, the Japanese enslavement and rape of "comfort women" during the Second World War.

But most cases that have been publicized and widely condemned have been in the past decade. Rhonda Copelon, a professor of law in New York and an expert on women's rights issues, has said that until a decade ago, whether rape was a war crime was a matter of debate. It was June of this year before the United Nations Security Council affirmed that rape and other forms of sexual violence can constitute war crimes, and called for measures to combat such attacks.

At least part of the motivation was the shock felt around the world by the systematic and widespread rape, torture and murder of women and girls in Bosnia-Herzegovina and Rwanda in the 1990s.

While men and boys have also been victims of war, these particular forms of violence against unarmed non-combatants have been used primarily on women and girls.

And the end of conflict is not necessarily the end of rape and sexual slavery. The World Health Organization noted in 2002 that "in many countries that have suffered violent conflict, the rates of interpersonal violence remain high even after cessation of hostilities, among other reasons because of the way violence has become more socially acceptable ... ." In countries such as Liberia and the Democratic Republic of Congo, which are officially in a "postconflict" state, for instance, violence against the female population continues.

Source: UN Office for the

Co-ordination of Humanitarian


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