Rape as a weapon of war in modern conflicts

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c3270 (Published 24 June 2010) Cite this as: BMJ 2010;340:c3270
  1. Coleen Kivlahan, volunteer forensic physician 1,
  2. Nate Ewigman, graduate student2
  1. 1Volunteer Physician Human Rights Clinic, Healthright International, 80 Maiden Lane, Suite 607, New York NY 10038, USA
  2. 2Department of Clinical and Health Psychology, University of Florida, PO Box 100165, Gainesville, FL, 32610-0165, USA
  1. ckivlahan{at}hotmail.com

    Families and communities are victims, as well as individuals

    Rape is deployed as a weapon of war in countries throughout the world, from Bosnia to Sudan, Peru to Tibet.1 Rape includes lack of consent to sex as well as provision of sex to avoid harm and obtain basic necessities. The Rome Statute of the International Criminal Court recognises that rape and other forms of sexual violence by combatants in the conduct of armed conflict are war crimes and can constitute genocide.2 Sexual violence such as forced marriage, female genital mutilation, and rape as a precursor to murder constitute torture under international law and are breaches of the Geneva Convention.2 Rape, as with all terror warfare, is not exclusively an attack on the body—it is an attack on the “body politic.” Its goal is not to maim or kill one person but to control an entire sociopolitical process by crippling it. It is an attack directed equally against personal identity and cultural integrity.2

    Rape has long been perpetrated during war. Since the second world war, however, rape has assumed strategic importance, and is now a deliberate military strategy.3 Women are now not only raped but physically scarred and mutilated.4 In recent conflicts, rape has been used as a reward for victory in battle, a boost to troop morale, as punishment and humiliation for both men and women, to incite revenge in opposing troops, to eliminate or “cleanse” religious or political groups, and to destabilise entire communities by creating terror.5 6

    When rape is used as an instrument of war it is perpetrated against pregnant women, infants and elderly women, men, fleeing refugees, and the internally displaced. We do not know the prevalence of rape during war because no international detection or reporting system exists, and rape is often not reported for fear of further violence. Information on prevalence generally comes from focused studies in individual countries. In the Democratic Republic of the Congo 16 000 rapes occurred in 2008 alone, and in South Kivu province, health centres estimate that 40 women were raped in the region daily.7 In 2005-6, a Liberian survey showed that 92% of interviewed women had experienced sexual violence, including rape.1 In the United Kingdom, 50-70% of female asylum applicants were raped, witnessed rape, or had a credible fear of rape.2

    Geographical, cultural, religious, political, legal, and behavioural conditions affect the likelihood of the systematic use of rape.4 6 Geographically remote locations allow perpetrators to rape with impunity. The likelihood that women will be raped, shamed, and isolated is increased in cultures with strong traditions regarding virginity, marital fidelity, and genital cleanliness. In addition, religions with strong beliefs about appropriate female clothing and behaviour increase the risk that women will be falsely accused of adultery and raped as humiliation and punishment. Political and legal climates of terror and lawlessness allow military personnel and police to rape as a matter of course. These factors make it unlikely that most victims will ever report their crimes.

    The effects of rape and sexual torture on survivors are economically, physically, psychologically, and culturally devastating. Survivors can be left with economic deprivation, AIDS, and sexually transmitted diseases.1 4 6 Victims experience serious acute and chronic medical problems, forced pregnancy, higher maternal mortality, miscarriage, infertility, and chronic sexual dysfunction.6 8 Because victims are often raped with a variety of objects—from body parts to guns, knives, bottles, and sticks—they are at risk of fistula formation, cervical cancer, and recurrent infections.2

    The psychological effects are extensive. Victims develop fear of intimacy, self injury, flashbacks, sleep disorders,9 and chronic psychosomatic problems such as headaches and gastrointestinal disorders.10 Rape is more likely to induce post-traumatic stress disorder than events such as robberies, deaths of a close friend or family member, or natural disasters.11

    The effects of rape extend to the family and community. The family struggles to accept the victim back into her home, or abandons her completely, often leaving her children without property or support, and leaving her in worsening poverty.2 Men whose partners or wives have been raped are humiliated and may become violent towards their partner.1 Half of rape victims in Sierra Leone reported that their relationships with family and friends were deeply affected.8

    Rape is also an attack on the culture and safety of the community and is accompanied by other acts of terror that disrupt basic services such as education, farming, commerce, and access to health care. The threat of rape restricts core activities, such as collecting water and firewood and working on family farms. This results in fewer cooked meals and endangers family nutrition.2

    The international community has mounted a considerable response including efforts to uphold international law, enhance security in refugee settings, condemn countries where rape is a standard weapon of war, initiate trials of human rights abuse, and increase access to humanitarian organisations in high risk settings. Three international priorities have been proposed: to identify and remove sexual inequality and bias; to develop a unified international response to ban the use of rape as a weapon of war and implement strategies of prevention and awareness; and to eliminate impunity by implementing accountability and restitution for the crimes.2

    Effective responses to rape as a weapon of war by the medical and psychological communities include supporting mandatory reporting, increasing screening, bearing witness to the profound human cost of rape by investigating and documenting evidence, and adhering to standard treatment protocols with early and intense mental health support.

    Rape during armed conflict is not simply about military personnel, police, or terrorists. Before 2004, rape assailants in the Democratic Republic of the Congo were primarily affiliated with the military; however, after 2004, civilian rapes increased 17-fold while rapes by armed combatants decreased by 77%. This pattern suggests a disturbing acceptance of rape among civilians.12 Rape is the result of the lack of dedicated societal attention to the safety, respect, and prosperity of women in peace time, as well as in war.


    Cite this as: BMJ 2010;340:c3270


    • Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: (1) No financial support for the submitted work from anyone other than their employer; (2) No financial relationships with commercial entities that might have an interest in the submitted work; (3) No spouses, partners, or children with relationships with commercial entities that might have an interest in the submitted work; (4) No non-financial interests that may be relevant to the submitted work.”

    • Provenance and peer review: Commissioned; not externally peer reviewed.


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