92661 Assessing the Impact of Programming to Reduce the Stigmatization of Survivors of Sexual Violence in Eastern Democratic Republic of the Congo Final Report Women in War Program April 30, 2014 LOGiCA Study Series The International Bank for Reconstruction and Development / The World Bank 1818 H Street, NW Washington, DC 20433 All rights reserved First published November 2014 www.logica-wb.net This Study Series disseminates the findings of work in progress to encourage discussion and exchange of ideas on gender and conflict related issues in Sub-Saharan Africa. Papers in this series are not formal publications of the World Bank. The papers carry the names of the authors and should be cited accordingly. The series is edited by the Learning on Gender and Conflict in Africa (LOGiCA) Program of the World Bank within the Social, Urban Rural and Resilience Global Practice. This paper has not undergone the review accorded to official World Bank publications. The findings, interpreta- tions and conclusions herein are those of the author and do not necessarily reflect the views of the International Bank for Reconstruction and Development/World Bank and its affiliated organizations, its Executive Directors, or the governments they represent. To request further information on the series, please contact vphipps@worldbank.org LOGiCA. Papers are also avail- able on the LOGiCA website: www.logica-wb.net. Cover design and text layout: Duina Reyes Photos provided by MONUSCO photo library HARVARD HUMANITARIAN INITIATIVE Assessing the Impact of Programming to Reduce the Stigmatization of Survivors of Sexual Violence in Eastern Democratic Republic of the Congo Final Report Women in War Program APRIL 30, 2014 Table of Contents Executive Summary.................................................................................................... 3 Part I. Project Context ............................................................................................... 6 Issue Background.................................................................................................................................................... 6 Project Introduction............................................................................................................................................... 6 Part II. Methodology.................................................................................................. 8 Key-Informant Interviews with CAMPS Department Directors................................................................. 8 Interviews with Service Beneficiaries and Family Members......................................................................... 8 Data Analysis........................................................................................................................................................... 8 Final Conference – Dissemination and Reflection on Project Findings..................................................... 9 Part III. Findings .....................................................................................................10 CAMPS Programming Model ..........................................................................................................................10 Beneficiary Needs after Sexual Violence..........................................................................................................11 Assessment of Beneficiaries................................................................................................................................11 Distribution of Services.......................................................................................................................................13 Programmatic Strengths......................................................................................................................................13 Integrated Services are Critical for Effective Recovery.................................................... 13 Psychosocial Care Provides a Foundation for Long-term Healing................................ 14 Services Must Address the Survivor’s Social Context...................................................... 14 .................................... 15 Socio-Economic Reinsertion Creates Long-Term Opportunities. Community Engagement Significantly Improves Services............................................... 16 Impact of Services . ..............................................................................................................................................16 Programmatic Weakness and Recommendations . .......................................................................................17 Part IV. Conclusion . ................................................................................................19 Bibliography.............................................................................................................22 Appendix 1. Overview of CAMPS Field Staff Details.............................................23 Appendix 2. Overview of Service Beneficiaries and Family Member Details........24 Appendix 3. Conference Schedule..........................................................................26 Appendix 4. Conference Discussion Questions . ..................................................27 Appendix 5. About the Authors, Funder ...............................................................29 2 Executive Summary S urvivors of conflict-related sexual violence in -- To understand positive and challenging as- eastern Democratic Republic of the Congo pects of the programs (DRC) report that the social stigma they face as a result of rape can sometimes be as traumatic as -- To reflect on previously implemented pro- the attack itself. Women who have been raped are of- grams and to learn from people’s experiences ten looked upon as morally and physically “tainted” with these programs and can face subtle and overt ridicule from family The results of the impact evaluation are detailed be- members, friends, and the community at large. Sur- low. First, overarching messages are presented and vivors report they may be called “wives” of their then challenges and associated recommendations rapists, perceived as carriers of sexually transmitted are outlined in table format. infections (STIs), including human immunodefi- ciency virus infection/acquired immunodeficiency Intense poverty among individuals in this context, syndrome (HIV/AIDS), and face an underlying even before they experience sexual violence, makes assumption that they can no longer be productive this a challenging context to work in. Compounding members of the community. This perception can this problem, the severity of attacks, which often lead to intense social isolation that, at its most ex- involve looting and burning of houses, leaves treme, involves women being made to physically programmers trying to address a wide range of leave their own homes or communities or being very basic needs among their beneficiaries that abandoned by their families. The phenomenon of went beyond the standard medical and mental stigma and rejection impact a survivor’s psychologi- health needs. These needs included: finding hous- cal health, as well as their physical, economic, and ing; paying school fees; getting access to education social wellbeing. for themselves and their family members; and hav- ing enough to eat every day. This project rigorously evaluated programming that addresses stigma against survivors. In this program The range of beneficiary needs emphasizes the evaluation, the Harvard Humanitarian Initiative importance of undertaking integrated, compre- (HHI) worked with the Congolese NGO, Centre hensive programming that can address medical, d’Assistance Medico-Psychosociale (CAMPS) to psychological, and economic needs in parallel. assess which parts of their programming are most Respondents spoke about the positive synergy be- effective and how to continue to improve services tween receiving different kinds of services. Some related to reducing stigma. CAMPS is one of the noted that they need psychological care to get to most long established and wide-reaching providers reach a capacity in which they are able to leave their of these services. With offices in some of the most houses and undertake income-generating training. conflict-affected and remote areas, working with Others noted that they first needed medical care to CAMPS provides a unique opportunity to look at get to a point where they were healthy enough to do grass-roots models for addressing this issue. The counseling and then, by gaining a sense of mental goals of this work were: stability, they were able to successfully undertake family mediation and reunification. -- To hear both from beneficiaries and service providers about programs aimed at reducing Survivors noted that one of the most damaging se- stigma quelae from sexual violence was the social isolation Assessing the Impact of Programming to Reduce the Stigmatization of Survivors of Sexual Violence in Eastern Democratic Republic of the Congo 3 and rejection from their family and social networks. in disseminating behavior change messaging This could include being abandoned by one’s hus- around acceptance for survivors, and for creat- band, being forced to move out of a husband’s house, ing support networks among survivors. Finally, feeling so stigmatized that one was compelled to CAMPS leveraged its community connections to move to another village, or isolating oneself by not respond rapidly to emerging needs. An example of going to public spaces like church or markets. Sur- this is their “community relay” system (RECO) that vivors spoke about the importance of regaining a identifies needs in remote communities that can ap- sense of respect and dignity among their family ply for assistance from the CAMPS coordination of- and peers as a key aspect of healing from sexual fice, which will then send staff members or a mobile violence. For this reason, services must address clinic to respond to emergency situations. not only an individual’s needs but must also fa- CAMPS uses a victim-centered approach that al- cilitate reintegration and healthy relationships lows beneficiaries to choose which services and with family and peers. Respondents in this work referrals will be most helpful for them. Rather noted that family mediation could often be very ef- than having CAMPS staff prescribe who will access fective at reuniting a survivor with her family, and which set of services, they use the process of psy- particularly with her husband. A relatively healthy chosocial counseling as an avenue for understand- marriage could then help facilitate good relation- ing and assessing the needs of each person. Through ships with the extended family and community. counseling sessions, a staff member will understand When done effectively, socio-economic reinser- the specific needs of an individual, and their capac- tion activities can provide an avenue for sustain- ity to engage in a more involved process (like being able income beyond the immediate program. part of a group of people learning a new job skill) Some beneficiaries spoke of being able to purchase and provides options of available services. The final land, build a house, or pay for their children’s school decision about which services to access is left to the fees as a result of this assistance. Communities must survivor. be engaged in deciding which income-generating In addition to the overarching messages and best activities are most appropriate for their context. practices identified above, beneficiaries and service Even after doing an assessment of which activities providers identified a number of challenges with to undertake, it can be challenging to find activities the current service provision landscape. These have that provide sustainable income. Some beneficiaries been synthesized into the following table 1. asked for more options to choose from when doing income-generating training. Others requested mi- Despite challenges around funding mechanisms, crofinance programs in addition to job skills. consistency of services, and difficulty accessing re- mote areas, beneficiaries expressed overwhelming Community engagement is critical at every step gratitude and deep appreciation for the care and as- of service assessment and provision. CAMPS de- sistance they received. Participants used powerful veloped a number of best practices related to com- metaphors to describe the effect that services had on munity engagement at all levels of service provision. them, such as “coming back to life,” feeling “human” CAMPS has found ways to engage communities again, and feeling as capable as they had before the in tailoring services for each context; in creat- assault. The combination of medical, psychosocial, ing word of mouth campaigns to ensure people and economic reinsertion activities was described as know where and how to seek their services; critical for holistic recovery. 4 Challenge Recommendation Inconsistent funding and shifting donor Employ socio-economic activities that not only offer priorities make it difficult for CAMPS to provide long-term benefits to beneficiaries, but also allow for long- consistent, holistic services. term stability to CAMPS. One specific suggestion was for CAMPS to develop an animal husbandry program where beneficiaries would be trained and acquire livestock, while CAMPS would also be able to maintain the program as the animals reproduced. In addition, CAMPS could draw on programs offered by other NGOs to expand their referral network and continue to focus on the programmatic areas they specialize in, such as counseling and socio-economic reintegration. Not all beneficiaries received the same Seek to ensure that all beneficiaries have access to the services, which resulted in tension and gossip same opportunities so as to reduce further stigmatization among beneficiaries. This was particularly of certain beneficiaries and make all feel equally supported true regarding access to socio-economic and valued. One specific suggestion was to decrease the reinsertion, which was only provided to a amount of services provided to some to allow for enough select group of beneficiaries based on the funding for all to receive the same services. The victim- resources available for distribution. centered approach described in the conclusion of the report recommends involving beneficiaries in choosing the services they receive. While limited funding can make it difficult to provide a number of different services to all, survivors should be involved to the extent possible in decisions about how services are delivered. Husbands and other family members are Create integrated models of programming that provide not given access to services, particularly both individual support and family –oriented services. medical care and counseling, which can create Beneficiaries discussed the importance of including family circumstances in which women would need to members the process of healing. Family mediation and seek repeat assistance. counseling are important from a psychosocial standpoint. In the case of married couples, it is vital that husbands also obtain medical care along with their wives, particularly for STI testing and treatment. Beneficiaries noted that currently only women have access to medical care, resulting in cases where the untreated husband continues to infect his wife. Given CAMP’s funding, it would be most realistic if they built partnerships with other NGOs to broaden the spectrum of potential services. Thus, male family members could potentially be referred to other NGOs for medical services and income generating training where possible. Access is limited to remote areas where Leverage CAMPS’ deep community connections and expand individuals’ needs are great. the community relay (RECO) system to continue to reach remote communities and share information about services provided by CAMPS. Build networks of former beneficiaries who can serve as community workers and educators in places where CAMPS is not able to work. CAMPS locations are not always near medical CAMPS should attempt to co-locate their offices with facilities, making it difficult for those in need to organizations that provide basic medical care, like malaria access both medical and psychosocial care. treatment, in order to make it easier for beneficiaries to fulfill all of their health needs. One example in which CAMPS has done this successfully is the office location in Walungu Centre, as it is nearby a general hospital. Assessing the Impact of Programming to Reduce the Stigmatization of Survivors of Sexual Violence in Eastern Democratic Republic of the Congo 5 Part I. Project Context Issue Background CAMPS has served survivors of sexual violence in the eastern DRC since 2002, providing psychosocial Survivors of conflict-related sexual violence in east- support, medical assistance, legal assistance, and so- ern Democratic Republic of the Congo (DRC) re- cio-economic reinsertion services, with the ultimate port that the social stigma they face as a result of rape goal of preventing sexual violence against women, can sometimes be as traumatic as the attack itself youth and children in the provinces of South Kivu, (Kelly, Kabanga, Cragin et al. 2012). Women who Maniema, Kinshasa and Kisangani. have been raped are often looked upon as morally and physically “tainted” and can face subtle and overt The results from this previous project highlight the ridicule from family members, friends, and the com- highly destructive effects of isolation and familial munity at large (Albutt et al. 2013). Survivors report rejection on survivors. In some cases, women not- they may be called “wives” of their rapists, perceived ed that the social exclusion they faced after sexual as carriers of sexually transmitted infections (STIs), violence could be worse than the attack itself since including human immunodeficiency virus infec- it resulted in ongoing economic, psychosocial, and tion/acquired immunodeficiency syndrome (HIV/ emotional devastation. AIDS), and face an underlying assumption that they A main finding from this previous work is the im- can no longer be productive members of the com- portance of having allies within communities who munity (Kelly, Kabanga, Albutt et al. 2012). This can advocate for the acceptance of women who perception can lead to intense social isolation that, have survived sexual violence, and to engage family at its most extreme, involves women being made to members in the acceptance process. Findings from physically leave their own homes or communities or both survivors and their male relatives speak to the being abandoned by their families (Bastick 2007). importance of services that explicitly address nega- The phenomenon of stigma and rejection impact tive attitudes towards survivors of sexual violence a survivor’s psychological health, as well as their in their family, peer, and community networks, and physical, economic, and social wellbeing (Kelly, Ka- provide positive coping skills to the family. banga, Albutt et al. 2012). This project rigorously evaluated programming Project Introduction that addresses stigma against survivors. In this pro- gram evaluation, HHI worked with CAMPS to as- In a previous project, the Harvard Humanitarian Ini- sess which services are effective and which can be tiative (HHI), in collaboration with the Congolese improved related to reducing stigma. CAMPS is NGO, Centre d’Assistance Medico-Psychosociale one of the oldest and most wide-reaching providers (CAMPS), investigated the impact of social isola- of these services, with offices in some of the most tion and stigma on survivors of sexual violence in conflict-affected and remote areas. Working with eastern DRC. This project represented a close col- CAMPS provides a unique opportunity to look at laboration between an academic partner dedicated grass-roots models for addressing this issue. The to bringing evidence based evaluation to crisis situ- goals of this work were: ations - HHI - and a Congolese service provision organization - CAMPS - that offers holistic services -- To hear both from beneficiaries and service to vulnerable women, with a focus on survivors of providers about programs aimed at reducing sexual violence. stigma 6 -- To understand positive and challenging as- how best to improve programming around stigma pects of the programs against survivors of sexual violence in DRC. HHI staff conducted an evaluation of CAMPS programs -- To reflect on previously implemented pro- and compiled recommendations for improving pro- grams and to learn from people’s experiences gramming related to reducing stigma. HHI created with these programs conference and training materials that were used in dissemination activities during the project timeline This project attempts to add to the evidence base of and can be used in future trainings by CAMPS. Assessing the Impact of Programming to Reduce the Stigmatization of Survivors of Sexual Violence in Eastern Democratic Republic of the Congo 7 Part II. Methodology D ata collection occurred between February and March 2014 and consisted of key-infor- Figure 1. Map of Project Sites mant interviews in Bukavu with the direc- tors of each type of service provided by CAMPS. This was followed by visits to three field sites to interview service beneficiaries, their family mem- bers, and CAMPS field staff. Finally, a dissemination conference was held in Bukavu on April 29, 2014 to convene practitioners, service providers and experts around the question of how best to provide stig- ma-reduction programming to survivors of sexual violence, their family members, and their communi- ties. Key-Informant Interviews with CAMPS Department Directors Seven interviews with field staff responsible for the three sites, Minova, Walungu Centre, and Muzinzi, were conducted. Details of the CAMPS field staff can be found in Appendix 1. Each key informant was administered a semi-structured questionnaire that sought to collect information relating to the dis- tribution of services to potential beneficiaries; the by beneficiaries followed the CAMPS model of ser- strengths and weaknesses of the programming; and vice disbursement, with many first receiving psy- suggestions for improvement. Demographic details chosocial assistance, followed by medical care, and of the key informants can be found in Appendix 1. then socio-economic support. Not all beneficiaries Interviews with Service Beneficiaries received all services; no one interviewed had re- and Family Members ceived legal assistance. A semi-structured qualitative questionnaire was administered to participants to The HHI research team visited three field sites where examine their experiences with CAMPS, their sug- CAMPS is active - Minova, Walungu Centre, and gestions for improvements, and their opinions on Muzinzi1 - and conducted 19 interviews with service the strengths and weaknesses of the services. beneficiaries and family members. Demographic de- tails of the interviewees can be found in Appendix Data Analysis 2. With few exceptions, the programming described Interviews with beneficiaries, their family mem- bers and service providers were audio-recorded and then translated into English. Two members of the 1  Muzinzi is not included on this map because it is currently not available on Google Maps, given its size and remoteness. It should be research team undertook close readings of the tran- noted that Muzinzi is about an hour drive from Walungu. scripts to identify salient themes. These individuals 8 generated themes independently; those that were the issue of stigmatization of survivors of agreed upon by both researchers were then defined sexual violence in South Kivu. In particular, as codes. Themes were refined through an iterative to promote discussion on the challenges, best process during the coding of the transcripts to better practices, and lessons learned. capture the emerging themes and subthemes, as well as relationships between these themes. Coding was -- Connect service providers and practitioners undertaken by one team member in NVivo 8 (QSR working on reducing stigmatization of survi- International, Cambridge, Mass.). Coded data was vors of sexual violence. then read by two team members and parsed into -- Share results of an evaluation conducted salient topics. Team members crosschecked each jointly by CAMPS and HHI of programming other’s analyses to validate main findings. related to reducing stigmatization of survivors Final Conference – Dissemination of sexual violence. and Reflection on Project Findings The twenty-eight participants represented a range of programmatic fields, including: medical, psychoso- A dissemination conference was held in Bukavu, cial, economic and legal. An overview of CAMPS’ South Kivu on April 29, 2014 to bring together long-term experience implementing stigma reduc- practitioners, who work on sexual violence pro- tion programs was presented in addition to the gramming, to reflect on the results of this work. The results of the evaluation. Details about the confer- objectives of the conference were to: ence schedule can be found in Appendix 3. In the -- Create an opportunity for discussion around latter part of the conference, participants were asked to break into two different Figure 2. Conference Attendees Listen to a Presentation breakout sessions. In the first by a Participant Following a Breakout Session in Bukavu session, participants split into groups by one of the four pro- grammatic areas – medical, psychosocial, economic or legal – and discussed project findings related to their field of expertise. In the second break- out session, participants split into four groups with mixed expertise and each group dis- cussed three overarching ques- tions related to some of the challenges that arose from the data, and how they have over- come or would suggest over- coming these challenges. The discussion questions present- ed in the breakout sessions can be found in Appendix 4. Assessing the Impact of Programming to Reduce the Stigmatization of Survivors of Sexual Violence in Eastern Democratic Republic of the Congo 9 Part III. Findings This section presents an analysis of the qualitative CAMPS Programming Model data reported by survivors of sexual violence who were beneficiaries of CAMPS services, their family As previously discussed, CAMPS manages four members, and service providers. The data collected separate but interconnected service programs, in- fell into the following categories: Beneficiary needs cluding Psychosocial Support, Medical Assistance, after sexual violence; Assessment of Beneficiaries; Legal Assistance, and Socio-Economic Reinsertion. Distribution of Service; Programmatic Strengths; Each service program follows a protocol to assess Programmatic Weaknesses, and Suggestions for beneficiaries and determine whether a referral for Improvement. Before presenting the results of the disbursement of that service is recommended. Be- qualitative data, the CAMPS programming model is low is a basic overview of the ways in which referrals provided below to give context about the approach occur. to providing different kinds of care for survivors. Survivor arrives at CAMPS office Psychosocial: When a potential beneficiary arrives at a CAMPS office, the first step is for a staff member to engage in an active listening session to learn about the individual and assess her or his needs and determine what, if any, referrals can be recommended. For those who receive services from CAMPS for an extended period of time, all receive psychosocial assistance through individual and group counseling sessions throughout their period of care. Medical: If the beneficiary is assessed to be in need of medical attention, CAMPS will provide a referral, transport, and pay the fees of care at a local hospital. For severe cases, referrals are made to Panzi Hospital in Bukavu; for less severe cases, local general hospitals are used. Legal: If the beneficiary knows the perpetrator of the sexual assault, then CAMPS begins to collect information about the case, as well as attempts to find the perpetrator and transport them to jail. CAMPS’ legal team then works to bring the case to court, which, ideally, would result in a conviction and jail time for the perpetrator. Socio-economic Reinsertion: If the beneficiary is both a survivor of sexual violence AND traumatized, they are eligible for financial support. Additionally, those classified as being particularly vulnerable, including those who become pregnant because of rape; widows; those divorced, rejected or stigmatized because of sexual violence; and those whose homes were looted or burned down, are considered high priorities for CAMPS. This support comes in different forms depending on the skills, experience, and interest of the individual, but examples included money or commodities to start a small business, animals for breeding, or tools for agriculture. 10 Beneficiary Needs after Sexual Beneficiaries and staff also spoke of the need for Violence families to be treated as a unit, rather than singling a survivor out for care. This was the case for both Before examining the provision of CAMPS’ services counseling and medical care, and will be addressed in particular, this project sought to examine the stat- in more detail in the following sections. ed needs of survivors of sexual violence. By doing so, it is possible to assess which services are addressed Assessment of Beneficiaries by CAMPS, and where there may still unmet need A key aspect of of the programming is the correct in this population. identification and appropriate engagement of ben- Beneficiaries and family members spoke of needing eficiaries. This project assessed this process from the psychosocial assistance, medical care, and family perspective of both the service provider and ben- mediation after experiencing sexual violence. Survi- eficiary. A number of effective practices, as well as vors and their families also spoke about the need for a number of challenges, were identified during the economic support. assessment stage. The stated needs of beneficiaries highlights one of Over the course of its programming, CAMPS has the fundamental challenges that CAMPS and other identified best practices for assessing and providing organizations face in this context – that many of their services to beneficiaries. A key strength of the pro- beneficiaries live in a state of poverty where even gramming was that CAMPS relies on community basic needs are not met. This reality complicates at- expertise to identify those in need during a crisis, as tempts to facilitate physical and mental healing after well as assist in community education. In order to sexual violence, and speaks to the importance of in- reach more remote communities, CAMPS has put in tegrated services that address material, psychosocial, place a “community relay” system (RECO) made up and health-related needs. In interviews, survivors of community leaders who identify needs in remote and their family stated that the following needs re- areas and then recommend individuals who may be sulted from sexual violence, which in the context of eligible to apply for assistance from the CAMPS co- eastern DRC often included looting, pillaging and ordination office. the destruction of one’s house and possessions: The RECO system relies on a number of pathways to • Houses, building materials for homes, accom- ensure active communication between beneficiary modation, land on which to build a house, communities and CAMPS. Within the community, rent members of the RECO systems conduct awareness- raising events that disseminate public service mes- • School fees for children and other needs re- sages, and may also identify potential beneficiaries. lated to childcare These events target different population groups, such as churches, schools, markets, men’s groups, etc. Ad- • Access to education or skills training for ben- ditional information is shared by having CAMPS eficiaries so that they are better qualified for community workers go door-to-door, distributing work; one beneficiary spoke of a 3-month information sheets, conducting workshops, and fa- adult literacy class that was too short to have cilitating “dialogue days,” where people are brought an impact together to discuss topics like children born of sexu- al violence, or stigma against rape survivors. • Accommodation for survivors traveling long distances to receive services CAMPS then uses cell phones to communicate be- tween the satellite offices and the headquarters. In • Food for themselves and their families addition, staff from field offices have scheduled visits • Access to loans for businesses to the main office in Bukavu to share information and relay reports. Finally, CAMPS staff use motorcycles • Employment opportunities or tools for work donated by the United Nations High Commission- Assessing the Impact of Programming to Reduce the Stigmatization of Survivors of Sexual Violence in Eastern Democratic Republic of the Congo 11 er for Refugees (UNHCR). Figure 3. The CAMPS office in Minova These are particularly crucial for reaching very remote areas not accessible by car. The mo- torcycles were cited as one the most effective ways to get rape survivors to a clinic for post- exposure-prophylactic (PEP) care in the recommended 72- hour window. In response to information re- ceived from RECO members, the CAMPS coordination of- fice will send a psychosocial and medical mobile clinic if those areas are accessible in terms of logistics and secu- rity. Even in cases where a mobile clinic is not able cases where their income generating activities could to travel to an affected area, the coordination office not provide for all of their needs (for instance if they may still send individual psychosocial and medical were farmers and had a bad crop). assistants to these areas. Finally, CAMPS has developed a practice over time Because of the process that draws heavily on com- to determine which services to give to each ben- munity input and vetting, there did not seem to be eficiary. Rather than taking a prescriptive approach an issue with women falsely claiming to be eligible where CAMPS staff decide who will access which for services for which they may not have qualified. set of services, they use the process of psychosocial Instead, the largest issues centered around not hav- counseling as an avenue for understanding and as- ing enough resources to accommodate all of those sessing the needs of each person. Through coun- who were eligible for services. Both service provid- seling sessions, a staff member will understand the ers and beneficiaries discussed a discrepancy be- specific needs of an individual, and their capacity to tween funder allocation and the amount of need. engage in a more involved process (like being part of For instance, one woman spoke about the fact that a cohort of people learning a new job skill) and gives the project provided support for 80 women, but them options about which services are available. The in a given community there may be 200 women in final decision about which services to access is left to need of services. It is therefore difficult for CAMPS the survivor. This model has parallels with best prac- to address the gap between funding and community tices in the United States geared towards survivors demand. of domestic violence. In the US model, providing In a similar process, CAMPS undertakes needs as- options for services that the survivor can choose sessments within communities before deciding from is seen as a healthy way to allow an individual which type of income-generating training to intro- to re-gain a sense of control and agency in a life that duce into a particular context – the goal is to intro- may have been bereft of these opportunities.2 duce economic activities that are appropriate and sustainable in the host community. Despite this, some beneficiaries noted that they would have been 2  While models of service provision are not often published in peer-reviewed literature, programmatic documents from organiza- happy to have more options related to the type of tions providing relevant services offer insight on best practices. The profession they could undertake. Others expressed Boston Area Rape Crisis Center (BARCC) stands as one example; interest in small savings and loans programs that they detail medical, legal, counseling, and case management services (BARCC, 2014). could help them withstand financial shocks in the 12 Distribution of Services Programmatic Strengths While assessment of survivors in need through the Beneficiaries and their family members expressed community processes described above is a strength overwhelming gratitude and deep appreciation for of CAMPS, the organization still faces financial con- the care and assistance they received. Furthermore, straints, which means they cannot always give the they detailed a desire that CAMPS would continue same services to all needy individuals within a com- to provide services as they continued to need sup- munity (particularly those who enrolled at different port and felt that there were many others who also times). Logistics, limited finances, and security limi- would benefit from CAMPS services. This section tations interact to determine which areas are acces- details the five main strengths described in the in- sible and practical to provide assistance. terviews. There was a consensus among beneficiaries that all Integrated Services are Critical for available funds and resources went directly to those Effective Recovery in need, with the minimum amount of funds being Participants discussed the importance of holistic used for overhead or administration (or misuse). care, including psychosocial, medical, and socio- Respondents also noted that CAMPS finds innova- economic services, and how there is a positive in- tive ways to address needs (an example was given terplay between the different types of programming. of CAMPS taking the initiative to start a collection For instance, beneficiaries needed psychosocial and among churches to help a community that had just medical care in order to feel functional again, which been attacked by rebels). Despite this, there was still then enabled them to participate in the income-gen- a certain amount of frustration among respondents erating activities. In return, the income-generating that, despite efforts to provide fair services, some trainings helped them continue to heal mentally by benefited more than others from services like in- facilitating social reintegration and acceptance in come generating activities. There was also a desire their families and communities. among beneficiaries to see services co-located where possible. In particular, beneficiaries spoke about the As one beneficiary noted, “The first thing I got when desire to have medical services more easily accessi- I came was the counseling that helped my thoughts ble. Currently, since CAMPS works in such remote and made me stable emotionally. Another thing I re- areas, accessing medical care can often involve dif- ceived was the medical assistance as I had infections ficult travel logistics. Working with NGOs to set up from the rape. I have been given treatment and now mobile medical clinics or medicine distribution on I am doing fine. I was a beneficiary of financial aid a set schedule may help address these issues. Finally, from CAMPS that made me feel more like a human there was discussion about the difficulty in accessing being and like I could interact with others because I medical care for both a survivor and her husband, a used to look at myself like I was dead. Also, when my critically important issue for treating problems like husband realized that I was doing a small business STIs. CAMPS faces donor limitations on who can and could supply to the need of my household, he came back to me. That is the reason why I used to receive medical services. This means that while fe- bless CAMPS a lot. I live today thanks to CAMPS.” male survivors can be treated for STIs, there is no provision for the treatment of her male partner. This Another woman echoed the positive interplay be- can result in women becoming re-infected by their tween services, noting it was hard to pick one as be- husbands or long-term partners. As one beneficiary ing the most helpful since there was synergy among from Walungu Centre said, “I went to CAMPS office the benefits, “For me all [of the programs] were help- to tell them about how I was feeling, and they sent ful, because I was suffering from mental sickness first me to the hospital and I got a good treatment again. and the counseling sessions help me to feel released, I’m doing fine, but my husband never received med- then physical sickness that made me fearful, also the ical treatment for infections so when we will meet financial help. Since my husband left me I was not as husband and wife, I’ll get infected again. That is capable of buying even a soap or sugar for my chil- what I fear.” dren, I was just staying at home worthless…” Assessing the Impact of Programming to Reduce the Stigmatization of Survivors of Sexual Violence in Eastern Democratic Republic of the Congo 13 Later in this section, we detail the ways in which in- wellness was that counseling allowed them to un- tegrated services also assist in family reconciliation. derstand that the sexual violence they experienced should not define their present. Another way that Psychosocial Care Provides a beneficiaries and their husbands in Minova de- Foundation for Long-term Healing scribed the path to normalcy was through receiving Participants emphasized the importance of psycho- advice to change one’s behavior and understand the social care and stated it was a necessary foundation difference between good and evil choices. for development in all other areas. Beneficiaries used Services Must Address the Survivor’s metaphors of “coming back to life” and gaining new Social Context respect from family and community by regaining a sense of mental stability and returning to normal. Survivors described how the shame and trauma re- Beneficiaries consistently noted that counseling was sulting from rape isolated them socially and could necessary for them to overcome symptoms linked result in them having to leave their families and to both rape and the resulting stigma, such as self- communities. Survivors spoke in particular about isolation, fearfulness, absent mindedness, etc., and the importance of promoting a good relationship to once again be able to participate in their social with their husband, since this was often the most networks and regain a much needed sense of stabil- important social relationship to women. A relatively ity and self-esteem. As one woman noted, “I was no healthy marriage could then help facilitate good re- longer a person, and [I] was withdrawing in myself lationships with their extended family and commu- and hiding as people were laughing at us as were nity. raped. CAMPS welcomed us, gave us direction, pieces of advice and we are so happy; we got medi- Family mediation was described as an effective po- cal assistance as our mind was shaken but we were tential intervention to prevent divorce and to re- healed.” Another beneficiary echoed this sentiment, unite separated couples. Survivors of violence noted saying, “I think the psychosocial help was the most that their husbands might abandon them after rape useful to me. I was not looking at myself as a human because of: pressure from their family, fear of con- being or a useful person, people were pointing at me tracting STIs and HIV/AIDS, and lack of trust or and that made me feel ridiculous…” understanding that rape is not voluntary, among other reasons. A number of beneficiaries described Finally, one woman described how her sense of the family mediation as one of the most important shame and trauma that had kept her from engaging services they received from CAMPS, though they in any aspect of normal life, resulting in her leav- also discussed the ways in which other services as- ing her husband and her village, had been allevi- sisted in familial and community reconciliation. ated by counseling. She was able to reunite with her husband and better cope with her trauma: “Since I Family mediation sessions sought to help make was raped, I was not going out of my hut anymore, spouses understand each other and their experi- I was so shy, could not socialize, I was fearful, I even ences, as well as to make husbands comprehend left my village because of shame. Those counseling that rape is not voluntary. One husband interviewed sessions helped to deal with all those feelings. My said that mediation was even more helpful than the family in law asked my husband to send me away, I financial assistance his wife received, “She was well came down here and stayed with my family with my cared for, she benefited [from] the counseling ser- children, and he joined us almost ten months after. I vice which helped to improve the relation between was going to CAMPS already, and I explained to him us as husband and wife, and strengthen our mar- how I benefit from counseling and how it helped me riage which was about to go in pieces because of deal with shame and all negative feelings.” suspicions and other problems we had. I was more impressed with the counseling than the financial A staff member from Muzinzi said that beneficia- aid she got…” While staff acknowledged that not all ries, through healing, “come back to normal life.” mediations were successful, beneficiaries and hus- One way beneficiaries explained this transition to bands repeated over and over how effective CAMPS 14 was in reuniting spouses. A woman from Walungu waste.” Both the behavior changes enabled by coun- Centre said the following of her own experience seling and the economic self-sufficiency offered by with her husband: They “needed to take care of the socio-economic reinsertion speak to the issue of pieces of advice from CAMPS and they will help us survivors of sexual violence being able to fulfill the live together. They really did because without those expectations of what it means to be a woman, which he would have been calling me names, saying I am allows for husbands to return to their marriages. The the wife of X, Y, Z.” same husband who spoke of money being wasted without mental health explained that “counseling One woman from Muzinzi described how her hus- helps them to behave well, be good wives and good band had rejected her, but then returned after learn- mothers in their homes.” ing she was healthy: Spousal reunion not only directly addressed stigma “That evening my husband promised to go experienced by survivors of sexual violence within with me the following day so that he could the family, but also fostered acceptance within one’s also check if I was not infected. ‘I have community and was often linked with regaining re- started running away from you because I spect from one’s family and peers. Some explained am thinking that the people who did this to how the return of one’s husband meant that those in you and your fellows might have infected the community who had pointed and gossiped be- you with AIDS, and I may also be infect- fore could no longer do that. Aside from reuniting ed…’ The nurse told my husband to be with husbands as improving community relations, free with me because I was not infected…. interviewees also commented how the socio-eco- Two days later he asked me if I was really nomic reinsertion earned them respect from others. not infected and I confirmed that I was re- One woman from Muzinzi explained, “Whoever ally not infected, but he suggested me to go would despise you cannot do it anymore when they back to hospital and we came back here. We see you having what belongs to you.” were … reconciled.” Socio-Economic Reinsertion Creates As mentioned above, beneficiaries said they benefit- Long-Term Opportunities ed from the behavior advice they received through psychosocial counseling, which allowed them to act Socio-economic reinsertion activities varied across normally. This was another way in which marriage sites and beneficiaries, ranging from the provision of reconciliation was facilitated as husbands said they cash or items to sell, like rice or sugar; participation were able to be with their wives now that they were in a savings cooperatives; or the donation of an ani- less aggressive and more affectionate. One husband mal, like goats or pigs; etc. At its most effective, this from Minova said of his wife: “She has become a assistance offered families sustainable income op- new person at home.” portunities beyond the immediate program. Some beneficiaries spoke of being able to purchase land, Socio-economic reinsertion was also described as build a house, or pay for their children’s school fees a driver for husbands to reconcile with their wives, as a result of this assistance. One survivor described though there was disagreement among intervie- how her training helped her become more indepen- wees on how important it was. Some beneficiaries dent, “I could not do business and did even know recounted how their husbands returned soon after how to do it, but since I went through the counsel- they saw they had either money or income gener- ing and received training about how to choose and ating activities. In contrast, some beneficiaries and do an activity generating income I may say that now some husbands said that the psychosocial assistance I can handle my self, I am capable of doing a small and family mediation services were more valuable business that enable me to supply my family need than the money and that money on its own was use- without waiting on someone else.” less without a strong mental and emotional base. One husband from Minova said, “Money without Another beneficiary noted that she was able to use good mental health is useless. It will be spoiled and a her financial training to pay rent and then to start Assessing the Impact of Programming to Reduce the Stigmatization of Survivors of Sexual Violence in Eastern Democratic Republic of the Congo 15 other small businesses like owning livestock and themselves created community networks and they selling foodstuffs, “The medical assistance did help go by saying as we have received the training freely me a lot to and even the financial help I received we will also pass it on freely, that’s the Gospel they through my daughter since it allows us to be paying got from CAMPS and they are raising other people’s the house rent of 5$ per month and not have to be awareness to come and benefit from CAMPS ser- pointed at everyday by the owner. The rest of the vices. For me that’s something very positive and it’s aid she bought the goat, fowl and do a small busi- a strength and regarding the coaching activity...” ness of sugar and powder soap along the street.” Another service provider echoed this sentiment, say- Another woman noted that the financial assistance ing “From their testimonies they encourage others also helped her heal mentally by keeping her occu- to join the programs and tell us, ‘Look, I’ve brought pied, saying, “I used to do business before but since my fellow because she has got the same problem like the incident (sexual violence) I was just staying at me,’ those are the examples of the testimonies we home, but now I am a busy woman selling fishing get from people, even from local authorities, pastors products.” and when we go to their churches for outreach and Community Engagement Significantly raising awareness, they welcome us and recommend Improves Services us to come back and talk about the topics we devel- oped previously.” As described in the Assessment of Beneficiaries sec- tion, engagement with the community in the pro- Impact of Services cess of establishing services; creating best practices; The impact of services on the individual was framed identifying potential beneficiaries; and engaging all within the context of personal revival. Participants community members in social change is critical. used powerful metaphors to describe the effect that CAMPS service providers spoke about the power services had on them, such as “coming back to life,” of community engagement for creating appropriate feeling “human” again, and that they felt capable as services, saying, “…before CAMPS provides a rein- they had before. Many beneficiaries said that the sertion related service, we organize field visits, we medical services they received were the reason why listen to the beneficiaries’ needs… it’s not CAMPS they were alive today. One woman from Minova who decides on the activities for Income Generation said that she “would be dead by now considering Activities, the beneficiaries make their own choices, how I suffered in my body and in my mind,” while i.e. they express their own need and the response is another woman from Minova said, “I live today accordingly…” thanks to CAMPS.” Additionally, some discussed how through recovering from injuries and illness, In addition, community sensitization sessions, par- they were able to function like they did prior to their ticularly those offered through churches, and word assaults. A woman from Walungu Centre explained of mouth from those who benefited from CAMPS that, “Once you are healthy, there is nothing you – both direct beneficiaries and their family members can’t do.” This was particular true regarding one’s – were listed as useful in helping others learn where ability to do work, like farming. Relatedly, socio- to seek services and for the community overall to economic reinsertion made some beneficiaries re- gain a better understanding of sexual violence and gain their sense of self-sufficiency, which added to its impact. CAMPS staff members and beneficia- the feeling of recovery and revival. ries spoke about the power of the “word of mouth” campaigns both to change attitudes around sexual The idea of returning to normal was also discussed violence and to make others aware of the available regarding beneficiaries’ mental health. Participants services. One service provider noted, “I can also tell talked about the need to overcome symptoms you that there’s involvement of the local authori- linked to both rape and the resulting stigma, like ties in the activities we do. I can also tell you, as an- being fearful, crying, isolating oneself, losing track other success, our beneficiaries have themselves be- of one’s thoughts, etc. Many beneficiaries described come agents to raise other people’s awareness; they feeling less than human and like they had no value, 16 but counseling helped return them to a sense of nor- However, the suggestions below reflect consistent malcy and humanity. A woman from Walungu Cen- themes arising from the data tre said, “I became almost nothing, but when I went to CAMPS I felt becoming a person reviving.” An- Challenge #1: Inconsistent funding and shifting donor other woman from Walungu Centre explained, “We priorities make it difficult for CAMPS to provide con- learned that we were still people.” sistent, holistic services. Beyond the individual impacts, beneficiaries talked Suggestion: Employ socio-economic activities that about how services also improved family and com- not only offer long-term benefits to beneficiaries, munity relationships. Marriage dissolution was de- but also allow for long-term stability to CAMPS. scribed as a common occurrence for survivors, as One specific suggestion was for CAMPS to devel- husbands left their wives for various reasons, includ- op an animal husbandry program where beneficia- ing pressure from their family, fear of contracting ries would be trained and acquire livestock, while STIs and HIV/AIDS, and/or lack of trust or un- CAMPS would also be able to continue to maintain derstanding that rape is not voluntary. Participants the program as the animals reproduced. In addition, described how several CAMPS services brought CAMPS could draw on programs offered by other reconciliation and reunion between spouses. Re- NGOs to expand their referral network and con- garding medical care, interviewees talked about how tinue to focus on the programmatic areas they spe- some husbands were willing to return to their wives cialize in, such as counseling and socio-economic after knowing that they were healthy and did not reintegration. have any infections or diseases. Challenge #2: Not all beneficiaries received the same Reconciliation among spouses also served to posi- services, which resulted in tension and gossip among tively impact beneficiaries’ relationships with their beneficiaries. This was particularly true regarding access to socio-economic reinsertion, which was only provided communities. Some explained how the return of to a select group of beneficiaries based on the resources one’s husband meant that those in the community available for distribution. who had formerly excluded her would become more welcoming. A staff member from Walungu said, “For Suggestion: Seek to ensure that all beneficiaries have instance, a victim who was rejected, she was support- access to the same opportunities so as to reduce fur- ed through mediation we conducted. The neighbors ther stigmatization of certain beneficiaries and make may comment on her rejection or may stigmatize all feel equally supported and valued. One specific her. This victim may be stigmatized or rejected by suggestion was to decrease the amount of services the family or the community. Now that today she provided to some to allow for enough funding for all lives harmoniously with her husband, the neighbors to receive the same services. will not comment.” A woman from Minova further explained how her reconciliation with her husband Challenge #3: Husbands and other family members brought her respect from others; she said, “[T] are not given access to services, particularly medical hanks that my husband is back and those who could care and counseling, which can create circumstances in not talk to me are now treating me with respect.” which wives would need to seek repeat assistance. Programmatic Weakness and Suggestion: Create integrated models of program- Recommendations ming that provide both individual support and fam- ily –oriented services. Beneficiaries discussed the Below are the most commonly raised challenges and importance of including family members the process suggestions for improvement that emerged from the of healing. Family mediation and counseling are im- interviews with beneficiaries and staff. Given that portant from a psychosocial standpoint. In the case different individuals received different services from of married couples, it is vital that husbands also ob- CAMPS, some of the challenges and resulting sug- tain medical care along with their wives, particularly gestions may seem inconsistent with each other. for STI testing and treatment. Beneficiaries noted Assessing the Impact of Programming to Reduce the Stigmatization of Survivors of Sexual Violence in Eastern Democratic Republic of the Congo 17 that currently only women have access to medical provided by CAMPS. Build networks of former care, resulting in cases where the untreated husband beneficiaries who can serve as community workers continues to infect his wife. Given CAMP’s funding, and educators in places where CAMPS is not able it would be most realistic if they built partnerships to work. with other NGOs to broaden the spectrum of po- tential services. Thus, male family members could Challenge #5: CAMPS locations are not always near potentially be referred to other NGOs for medical medical facilities, making it difficult for those in need to services and income generating training where pos- access both medical and psychosocial care. sible. Suggestion: CAMPS should attempt to co-locate Challenge #4: Access is limited to remote areas where their offices with organizations that provide basic individuals’ needs are great. medical care, like malaria treatment, in order to make Suggestion: Leverage CAMPS’ deep community it easier for beneficiaries to fulfill all of their health connections and expand the community relay needs. One example in which CAMPS has done this (RECO) system to continue to reach remote com- successfully is the office location in Walungu Cen- munities and share information about services tre, as it is nearby a general hospital. 18 Part IV. Conclusion S urvivors of conflict-related sexual violence in -- To understand positive and challenging as- eastern Democratic Republic of the Congo pects of the programs (DRC) report that the social stigma they face as a result of rape can sometimes be as traumatic as -- To reflect on previously implemented pro- the attack itself. Women who have been raped are of- grams and to learn from people’s experiences ten looked upon as morally and physically “tainted” with these programs and can face subtle and overt ridicule from family The results of the impact evaluation are detailed be- members, friends, and the community at large. Sur- low. First, overarching messages are presented and vivors report they may be called “wives” of their then challenges and associated recommendations rapists, perceived as carriers of sexually transmitted are outlined in table format. infections (STIs), including human immunodefi- ciency virus infection/acquired immunodeficiency Intense poverty among individuals in this context, syndrome (HIV/AIDS), and face an underlying even before they experience sexual violence, makes assumption that they can no longer be productive this a challenging context to work in. Compounding members of the community. This perception can this problem, the severity of attacks, which often lead to intense social isolation that, at its most ex- involve looting and burning of houses, leaves treme, involves women being made to physically programmers trying to address a wide range of leave their own homes or communities or being very basic needs among their beneficiaries that abandoned by their families. The phenomenon of went beyond the standard medical and mental stigma and rejection impact a survivor’s psychologi- health needs. These needs included: finding hous- cal health, as well as their physical, economic, and ing; paying school fees; getting access to education social wellbeing. for themselves and their family members; and hav- ing enough to eat every day. This project rigorously evaluated programming that addresses stigma against survivors. In this program The range of needs emphasizes the importance evaluation, the Harvard Humanitarian Initiative of undertaking integrated, comprehensive pro- (HHI) worked with the Congolese NGO, Centre gramming that can address medical, psychologi- d’Assistance Medico-Psychosociale (CAMPS) to cal, and economic needs in parallel, in a way that assess which parts of their programming are most reflects the individual needs of the beneficiary. effective and how to continue to improve services Respondents spoke about the positive synergy be- related to reducing stigma. CAMPS is one of the tween receiving different kinds of services. Some most long established and wide-reaching providers noted that they need psychological care to reach a of these services. With offices in some of the most capacity in which they are able to leave their houses conflict-affected and remote areas, working with and undertake income-generating training. Oth- CAMPS provides a unique opportunity to look at ers noted that they first needed medical care to get grass-roots models for addressing this issue. The to a point where they were healthy enough to do goals of this work were: counseling and then, by gaining a sense of mental stability, they were able to successfully undertake -- To hear both from beneficiaries and service family mediation and reunification. While synergy providers about programs aimed at reducing between services was described as critically impor- stigma tant, the survivor herself should be able to choose Assessing the Impact of Programming to Reduce the Stigmatization of Survivors of Sexual Violence in Eastern Democratic Republic of the Congo 19 which combination, among the variety of services, ing support networks among survivors. Finally, would be most beneficial for her. CAMPS leveraged its community connections to respond rapidly to emerging needs. An example of Survivors noted that one of the most damaging se- this is their “community relay” system (RECO) that quelae from sexual violence was the social isolation identifies needs in remote communities that can ap- and rejection from their family and social networks. ply for assistance from the CAMPS coordination of- This could include being abandoned by one’s hus- fice, which will then send staff members or a mobile band, being forced to move out of a husband’s house, clinic to respond to emergency situations. feeling so stigmatized that one was compelled to move to another village, or isolating oneself by not CAMPS uses a victim-centered approach that al- going to public spaces like church or markets. Sur- lows beneficiaries to choose which services and vivors spoke about the importance of regaining a referrals will be most helpful for them. Rather sense of respect and dignity among their family than having CAMPS staff prescribe who will access and peers as a key aspect of healing from sexual which set of services, they use the process of psy- violence. For this reason, services must address chosocial counseling as an avenue for understand- not only an individual’s needs but must also fa- ing and assessing the needs of each person. Through cilitate reintegration and healthy relationships counseling sessions, a staff member will understand with family and peers. Respondents in this work the specific needs of an individual, and their capac- noted that family mediation could often be very ef- ity to engage in a more involved process (like being fective at reuniting a survivor with her family, and part of a group of people learning a new job skill) particularly with her husband. A relatively healthy and provides options of available services. The fi- marriage could then help facilitate good relation- nal decision about which services to access is left to ships with the extended family and community. the survivor. One challenge to this approach is that fact that available services may be dependent upon When done effectively, socio-economic reinser- funding constraints and geographic availability. For tion activities can provide an avenue for sustain- this reason, a previous recommendation suggested able income beyond the immediate program. the need for comprehensive and holistic program- Some beneficiaries spoke of being able to purchase ming. Thus, while survivors do not have to use all of land, build a house, or pay for their children’s school the services available, they should be able to choose fees as a result of this assistance. Communities must among a set of options, which combination of ser- be engaged in deciding which income-generating vices would be most beneficial for them. activities are most appropriate for their context. Even after doing an assessment of which activities In addition to the overarching messages and best to undertake, it can be challenging to find activities practices identified above, beneficiaries and service that provide sustainable income. Some beneficiaries providers identified a number of challenges with asked for more options to choose from when doing the current service provision landscape. These have income-generating training. Others requested mi- been synthesized into the following table: crofinance programs in addition to job skills. Despite challenges around funding mechanisms, Community engagement is critical at every step consistency of services, and difficulty accessing re- of service assessment and provision. CAMPS de- mote areas, beneficiaries expressed overwhelming veloped a number of best practices related to com- gratitude and deep appreciation for the care and as- munity engagement at all levels of service provision. sistance they received. Participants used powerful CAMPS has found ways to engage communities metaphors to describe the effect that services had on in tailoring services for each context; in creat- them, such as “coming back to life,” feeling “human” ing word of mouth campaigns to ensure people again, and feeling as capable as they had before the know where and how to seek their services; assault. The combination of medical, psychosocial, in disseminating behavior change messaging and economic reinsertion activities was described as around acceptance for survivors, and for creat- critical for holistic recovery. 20 Challenge Recommendation Inconsistent funding and shifting donor Employ socio-economic activities that not only offer priorities make it difficult for CAMPS to provide long-term benefits to beneficiaries, but also allow for long- consistent, holistic services. term stability to CAMPS. One specific suggestion was for CAMPS to develop an animal husbandry program where beneficiaries would be trained and acquire livestock, while CAMPS would also be able to maintain the program as the animals reproduced. In addition, CAMPS could draw on programs offered by other NGOs to expand their referral network and continue to focus on the programmatic areas they specialize in, such as counseling and socio-economic reintegration. Not all beneficiaries received the same Seek to ensure that all beneficiaries have access to the services, which resulted in tension and gossip same opportunities so as to reduce further stigmatization among beneficiaries. This was particularly of certain beneficiaries and make all feel equally supported true regarding access to socio-economic and valued. One specific suggestion was to decrease the reinsertion, which was only provided to a amount of services provided to some to allow for enough select group of beneficiaries based on the funding for all to receive the same services. The victim- resources available for distribution. centered approach described in the conclusion of the report recommends involving beneficiaries in choosing the services they receive. While limited funding can make it difficult to provide a number of different services to all, survivors should be involved to the extent possible in decisions about how services are delivered.. Husbands and other family members are Create integrated models of programming that provide not given access to services, particularly both individual support and family –oriented services. medical care and counseling, which can create Beneficiaries discussed the importance of including family circumstances in which women would need to members the process of healing. Family mediation and seek repeat assistance. counseling are important from a psychosocial standpoint. In the case of married couples, it is vital that husbands also obtain medical care along with their wives, particularly for STI testing and treatment. Beneficiaries noted that currently only women have access to medical care, resulting in cases where the untreated husband continues to infect his wife. Given CAMP’s funding, it would be most realistic if they built partnerships with other NGOs to broaden the spectrum of potential services. Thus, male family members could potentially be referred to other NGOs for medical services and income generating training where possible. Access is limited to remote areas where Leverage CAMPS’ deep community connections and expand individuals’ needs are great. the community relay (RECO) system to continue to reach remote communities and share information about services provided by CAMPS. Build networks of former beneficiaries who can serve as community workers and educators in places where CAMPS is not able to work. CAMPS locations are not always near medical CAMPS should attempt to co-locate their offices with facilities, making it difficult for those in need to organizations that provide basic medical care, like malaria access both medical and psychosocial care. treatment, in order to make it easier for beneficiaries to fulfill all of their health needs. One example in which CAMPS has done this successfully is the office location in Walungu Centre, as it is nearby a general hospital. Assessing the Impact of Programming to Reduce the Stigmatization of Survivors of Sexual Violence in Eastern Democratic Republic of the Congo 21 Bibliography Albutt K, Kelly J, Kabanga J & VanRooyen M 2013, “Stigmatization and Rejection of Survivors of Sexual Violence in Eastern DRC,” Unpublished manuscript, Harvard School of Public Health. Boston Area Rape Crisis Center (BARCC) 2014. “BARCC Services.” Available at http://www.barcc.org/ join/about/services. Bastick MK, Grimm K & Kunz R 2007, Sexual Violence in Armed Conflict: Global Overview and Implica- tions for the Security Sector, Geneva Centre for the Democratic Control of Armed Forces, Geneva. Kelly J, Kabanga J, Albutt K, Maclin B, Im S, Kissenkoetter M & VanRooyen M 2012, “A Patient Heart: Stig- ma, Acceptance and Rejection around Conflict-Related Sexual Violence in the Democratic Republic of the Congo,” Unpublished manuscript, Harvard School of Public Health. Kelly J, Kabanga J, Cragin W, Alcayna-Stevens L, Haider S & VanRooyen M 2012, ‘“If your husband doesn’t humiliate you, other people won’t”: gendered attitudes towards sexual violence in eastern Democratic Republic of Congo’, Global Public Health: An International Journal for Research, Policy and Practice, vol. 7, no. 3, pp. 285-298. 22 Appendix 1 Overview of CAMPS Field Staff Details Role Age Gender Years of service Chef d’Antenne 50 M 7 years Psychosocial 52 F Since 2010 Assistant Psychologist 33 F Since July 2012 Psychosocial 47 F 2008 Assistant Chef d’Antenne 54 M 10 years Chef d’Antenne 46 M July 2013 Psychosocial 39 M 5 years Assistant Assessing the Impact of Programming to Reduce the Stigmatization of Survivors of Sexual Violence in Eastern Democratic Republic of the Congo 23 Appendix 2 Overview of Service Beneficiaries and Family Member Details Minova Years receiving Role Age Gender services Beneficiary 28 F Since 2012 Beneficiary 27 F 5 years Beneficiary 19 F Since Dec. 2013 Beneficiary 42 F Since July 2013 Beneficiary 19 F Since Oct. 2013 Beneficiary 20 F Since 2013 Beneficiary 42 F 1 year, 9 months Husband of Wife has received 54 M beneficiary care for 3 years Husband of Wife has received 55 M beneficiary care since 2012 Walungu Centre Years receiving Role Age Gender services Beneficiary 23 F 5 months Beneficiary 30+ F Since 2007 Beneficiary 45 F 4 years Beneficiary 32 F 5 years Husband of 30+ M Since Aug. 2006 beneficiary Husband of Unclear (since the 59 M beneficiary war) Husband of 47 M Almost 4 years beneficiary 24 Muzinzi Years receiving Role Age Gender services Beneficiary 26 F Since 2010 Beneficiary 40 F Since July 2012 Does not remember, but was one of the Beneficiary 40 F first to arrive at CAMPS office Assessing the Impact of Programming to Reduce the Stigmatization of Survivors of Sexual Violence in Eastern Democratic Republic of the Congo 25 Appendix 3 Conference Schedule PROGRAMME DETAILLE DE LA CONFERENCE 9 :00 – 9 :30 - Arrivée à la conférence - Bienvenue par CAMPS et HHI - Présentations des participants de l’atelier - Description de l’horaire de la conférence 9 :30 – 10 :00 - Présentation de CAMPS des efforts visant à réduire la stigmatisation et les leçons qu’ils ont tirées de ce travail par Justin Kabanga - Questions du groupe 10 :00 – 11 :00 - Premier travail en carrefour et plénière - Discussion du thème en carrefour – ½ heure - Présentations des productions des groups en plénière – ½ heure 11 :00 – 11 :45 - Présentation du projet d’évaluation et des résultats de ce travail par Beth Maclin et Miracle Chibonga - Questions du groupe 11 :45 – 12 :45 - Déjeuner 12 :45 – 2 :15 - Second travail en carrefour et plénière - Discussion du thème en carrefour – 1 heure - Présentations des productions des groups en plénière – ½ heure 2 :15 – 2 :30 - Mot de Clôture 26 Appendix 4 Conference Discussion Questions Activités en Carrefour : SESSION I Groupe 1 : Assistance Socio-Économique Il a été constaté que les bénéficiaires veulent souvent avoir des services sociaux-économiques à long- terme et des revenus durables. Cependant, en réalité, il peut être très difficile de prévoir quels genres d’activités rapporteront les revenus à long terme. • Selon votre expérience, avez-vous vécu cela? • Si oui, qu’est-ce que vous pouvez envisager de faire pour améliorer le travail à l’avenir par rapport à ce résultat ? • Si non, qu’est-ce que vous avez trouvé qui est différent par rapport à ce résultat ? • Pensez-vous qu’il y a quelque chose d’important à ajouter à ce résultat pour qu’il devienne plus com- plet ou précis? Groupe 2 : Assistance Juridique Il a été constaté que les survivants n’accèdent pas souvent aux services juridiques, et cela demeure un défi. • Selon votre expérience, avez-vous vécu cela? ˏˏ Si oui, qu’est-ce que vous pouvez envisager de faire pour améliorer le travail à l’avenir par rapport à ce résultat ? • Si non, qu’est-ce que vous avez trouvé qui est différent par rapport à ce résultat ? • Pensez-vous qu’il y a quelque chose d’important à ajouter à ce résultat pour qu’il devienne plus com- plet ou précis? Groupe 3 : Assistance Psycho-Sociale Il a été constaté que les survivants de violences sexuelles et leurs familles pensent que le counselling était très utile pour la guérison ou le rétablissement. • Selon votre expérience, avez-vous vécu cela? Si oui, quel traitement de santé mental avez-vous trouvé très efficace? • Si non, qu’est-ce que vous avez trouvé qui est différent par rapport à ce résultat? • Pensez-vous qu’il y a quelque chose d’important à ajouter à ce résultat pour qu’il devienne plus com- plet ou précis? Groupe 4 : Assistance Médicale Il a été constaté que les survivants de violences sexuelles pensent que les soins médicaux faisaient ob- Assessing the Impact of Programming to Reduce the Stigmatization of Survivors of Sexual Violence in Eastern Democratic Republic of the Congo 27 jet de critique en ce qui concerne la guérison ou le rétablissement des patients. Cependant, ils ont af- firmé que les institutions médicales sont toujours éloignées, et les services étaient limités aux femmes victimes, et rien n’était fait pour leurs époux ; ceci a constitué un frein pour une guérison définitive surtout quand il s’agissait des IST. • Selon votre expérience, avez-vous vécu cela? ˏˏ Si non, qu’est-ce que vous avez trouvé qui est différent par rapport à ce résultat ? • Pensez-vous qu’il y a quelque chose d’important à ajouter à ce résultat pour qu’il devienne plus com- plet ou précis? Activités en Carrefour : SESSION II Question I : Les bénéficiaires des services ont constaté qu’il y a une interaction importante entre les différents services. Ils ont parlé avec insistance d’une interaction positive dans l’acquisition de l’assistance. Etes-vous d’accord avec cela selon votre expérience? Si oui, quelles sont les meilleures pratiques que vous trouvez rassurantes par rapport aux services voulus et les services fournis aux survivants ? Si vous n’êtes pas d’accord, qu’est-ce que vous proposeriez à la place? Question II : Comment engageons-nous efficacement la communauté afin de favoriser des changements des attitudes au- tour du stigma lié à la violence sexuelle? Comment pouvons-nous le faire même dans des régions éloignées? Quelles sont les meilleures pratiques face à ce défi? Question III: Les survivants ont dit que la réconciliation et l’acceptation par la famille étaient un des aspects les plus impor- tants pour la guérison. Quels sont les moyens efficaces pour impliquer les membres de famille dans le traite- ment et la guérison? Mais parfois la réconciliation de famille n’est pas possible. Quelles sont les meilleures pratiques dans une telle situation? 28 Appendix 5 About the Authors, Funder About the Women in War Program The Harvard Humanitarian Initiative’s (HHI) Women in War program seeks to investigate and address women’s needs in today’s most troubled settings. HHI’s network of diverse faculty, fellows, and researchers examines pressing issues that impact women’s security throughout the world. Our projects emphasize the unique vulnerabilities women face in humanitarian settings, including gender-based violence, other forms of exploitation and abuse, and economic insecurity. Our research identifies some of the consequences of social instability and violence on women’s livelihoods as well as the key role women can play as agents of social change. Our work highlights the ways in which women are vital actors in their communities - advocates for change, businesspeople, service providers, and leaders. HHI’s research attempts to capture the complexities and nuances of these roles and to explore how women interact with other actors. HHI’s investigations inform approaches to reduce the vulnerability of women in conflict and support com- munity-level resilience strategies. The Women in War program employs a participatory research approach grounded in collaborations with international and local non-governmental organizations and community- based associations. This approach helps us bring the voices of the experts – the women affected by violence and instability – to practitioners and policy makers to catalyze the development of more effective program- ming. The program’s goal is to translate the knowledge gained from working with affected communities into timely and impactful programming and policy. This report was produced by Jocelyn Kelly, the director of the Women in War program, and Beth Maclin, the research coordinator of the program. About LOGiCA Established in 2009, LOGiCA is a three and a half year program financed by a multi-donor trust fund of US$8.7 million. LOGiCA’s specific objectives are: • To increase gender-sensitive programming in demobilization and reintegration operations in the great lake region by better addressing the gender-specific needs of male and female ex-combatants; • To generate knowledge and good practice on how to address gender and conflict issues - with a focus on programs addressing demobilization and reintegration, gender-based violence, vulnerable women in conflict affected areas, and young men at-risk in Sub-Saharan Africa LOGiCA is built upon lessons from the Learning for Equality Access and Peace (LEAP) Program: LEAP was established in 2007 under the Multi-country Demobilization and Reintegration Program (MDRP) to strengthen the impact of Programs from a gender perspective. LEAP used a combination of gender-sensitive approaches and piloting activities which proved crucial in con- tributing to the MDRP’s understanding of gender issues facing demobilization and reintegration programs. Furthermore, LEAP served to identify a number of broader post-conflict gender issues with currently limited operational responses. Thus LOGiCA was established as a stand-alone initiative with a widened scope to ad- dress other critical gender and post-conflict issues, in addition to a retained focus on demobilization and re- integration in the Great Lakes Region in collaboration with MDRP’s phasing-out initiative – the Transitional Demobilization and Reintegration Program (TDRP). This project was financed by LOGiCA through the World Bank. Assessing the Impact of Programming to Reduce the Stigmatization of Survivors of Sexual Violence in Eastern Democratic Republic of the Congo 29 THE WORLD BANK 1818 H, Street N.W. Washington, D.C. 20433 www.logica-wb.org