Editor's note: This report includes descriptions of sexual and physical violence.
Dr. Denis Mukwege is not surprised by reports of Ukrainian women being raped by Russian soldiers in the war. For over two decades, he has treated tens of thousands of rape survivors, many of whom suffered complex gynecological injuries, inflicted by armed groups in his home country of the Democratic Republic of Congo.
"When the war in Ukraine started in February, we activists tried to advertise to the world that this will happen again. We need to be ready to treat victims," says Mukwege, who was a co-recipient of the Nobel Peace Prize in 2018 for his dedication to helping those who have experienced sexual violence in conflict.
Mukwege continues to speak out against these horrific acts today, not just in Congo but globally — including in the ongoing crisis in Ukraine. In a commentary for the medical journal The Lancet last week, Mukwege and a team of researchers called on the world to protect women and girls at risk of sexual violence, rape and trafficking in Ukraine — and find ways to help survivors. Matilda Bogner, head of the U.N.'s Human Rights Monitoring Mission in Ukraine, says the group has received "allegations of rape, including gang rape, attempted rape, forced nudity, threats of sexual violence against civilian women and girls, men and boys."
Based on evidence from previous conflicts, the researchers outline how sexual violence affects survivors, what kind of treatment they need and why this kind of violence keeps happening. Mukwege, who is in Washington, D.C., this week to meet with members of Congress to discuss ways to end the decades-long war in the Congo, spoke with NPR about these issues. This interview has been edited for length and clarity.
What compels someone to commit sexual violence in times of war?
When soldiers use rape, most of the time they are using it to traumatize a community, not just the victim. In Ukraine, for example, [President Volodymyr Zelenskyy said in a U.N. speech that] some women were raped in front of their children. When you do this, it's not really sexual. It's just to show your power and show how you can destroy. It's traumatizing to watch your mother or daughter raped right in front of you — and not be able to act at all.
We also have many cases where rape is followed by torture, like destroying the genitals of women. In Ukraine in 2014 or 2015, we activists started to talk to women who were raped in Donbas. They told us that sometimes Russian soldiers put them in a public place, naked with things written on their genitals and on their body. They did this to destroy people's confidence in themselves. To destroy the fabric of society.
That's barbaric. Does that actually work to destroy confidence?
It works. In 2015, I met four men from Syria in The Hague, Netherlands [for the world premiere of a documentary about Mukwege's work, The Man Who Mends Women]. They told me when they were fighting against Assad, they received photos of soldiers raping their wives. After that, these four guys lost hope in fighting in the war. They didn't see the reason to go on when their wives could be treated like that and they couldn't protect them. They felt powerless.
Is this kind of sexual violence by soldiers part of some larger military strategy?
It's a strategy. In Congo in 2010, soldiers raped 200 women over the course of a few days. That can't be done without a plan.
What might be surprising for people to learn about these wartime rapes?
People say that rape is sexual relations without consent. This is not the case. It's not a question of consent. It's a question of humiliation, destruction and power. This is completely different from sex.
I just can't understand why a soldier would make the awful decision to rape and torture others. They have mothers, sisters and families, and surely even before the war they had some kind of moral compass. Isn't it traumatizing for them, too?
It is. In 2011, I got to talk to some former child soldiers from Goma in eastern Congo. They were brainwashed to do these kinds of things by their higher-ups. They were told that because they had guns, they [could instill fear in people to] get everything they wanted — money, women and so on. And many boys believed that narrative and acted on it.
When they left the army, it was difficult for them. They couldn't sleep, they couldn't get back to a normal life. They thought they had to continue inflicting harm on other people. They were so traumatized by what they had done to the bodies of other people and the atrocities they had committed. So they need to be treated for this trauma.
From your past experience, what needs to happen in Ukraine to help women who have experienced sexual violence in this war?
The first thing to do is to prevent or abort a pregnancy. Sometimes soldiers rape women to get them pregnant as a way "cleanse" the population of their ethnicity.
And when you say "cleanse," you mean that soldiers will purposely impregnate women to change the ethnic makeup of the next generation. And the woman meanwhile faces very personal consequences.
If a woman has a child from these circumstances, she will be traumatized for the rest of her life, because now she must care for a child she never wanted to have.
Next is to check for sexually transmitted diseases, prevent infections and treat wounds, such as pelvic pain. These treatments can give people the confidence to feel that OK, this happened, but I was treated for it and physically everything is normal.
Then we need to provide psychological treatment for all victims. I don't accept that someone can be raped with extreme violence without coming out of it traumatized.
What about justice?
It's difficult to ask women at this moment to talk about what happened because they are still fighting to survive, they are still in full trauma. At the same time, we need to begin to collect proof from the health center and start to build judicial files for them so they can get justice.
Is the idea that the file will enable survivors to come to court at some point in the future?
They may not want the file now, but they may come back for it after one month, one year, even 10 years.
Is justice even possible?
Yes. And it's important so people understand they can't do bad things and go unpunished. I have one example, which was published [in a report in The Lancet in 2019]. [Local armed militia] were raping children under the age of 5 years.
In your report, you wrote that these girls were coming to your Panzi Hospital for treatment over the course of more than 3 years starting in 2013 in the village of Kavumu in the Democratic Republic of Congo. The injuries they sustained were "profound" and included bladder and anal injury that caused fecal and urinary incontinence. That's monstrous.
I put all my effort into stopping these rapes but I couldn't.
It was tough, according to your report, because Frederic Batumike, a powerful sitting member of the provincial parliament who led the local armed militia who were committing these acts, was covered by immunity under Congolese law.
I finally talked to a military judge and asked him: After raping more than 200 girls under 5 years old, do you think this is acceptable? And the judge used the law to call this a crime against humanity and arrested and prosecuted him.
Did that put an end to the rapes?
I was treating 3-4 girls a week at my hospital. But after his arrest, as soon as the week after, everything stopped. Justice can really make a difference.
Your line of work deals with the ugliest parts of humanity. What inspires you to go on?
It's not easy to work in conditions where you're seeing horrible things. But on the other hand, I can say the resilience of women is something that really fuels my courage to treat them. I also treat men and I can tell you there's a big difference. I don't think they recover as easily as women. Women always have a reason to stand up and restart their lives. They are living for their children, their families and to support others. Sometimes men just think about themselves. That's why I think women are very, very strong.