Other MSF activities in Shabunda

As well as providing free medical care to rape survivors, MSF also supports three primary health centres in and around Shabunda, improving access to health care by training local health staff, supplying drugs and medical materials and rehabilitating the centres themselves.

The previous state of health care in Shabunda was very poor. MSF also helps run nutritional and medical services for some 250 malnourished children. MSF plans to expand its programmes in the area, and is trying to convince other organisations to come and work there.

The inhabitants of Shabunda, eastern Congo, have suffered almost every conceivable misery over the past few years: war, genocide, starvation, disease and displacement. But there is now another horror stalking them - the mass rape of their womenfolk.

Shabunda is a small, unremarkable town nestling in the impenetrable Congolese forest, not far from the border with Rwanda. Unfortunately for the people who live there, Shabunda is a strategically convenient place for the warring parties in the region to stop awhile, and the town has changed hands a number of times since the fighting started in 1996. At the moment the jungles surrounding it are home to vicious killers and rapists. People call them the Mai Mai, the traditional term for indigenous militias set up to defend their people. But these fighters have no desire to protect the population, instead they are responsible for mass rape and other crimes.

The trouble started two years ago when Mai Mai first attacked the town. Terrified, people fled into the forest. Two months later women started reappearing with tales of abduction, sexual slavery and murder. Over 500 women have testified that they were raped whilst in the forest, from girls as young as eleven to grandmothers in their seventies.

These attacks are still going on. Driven by hunger and desperation, the women of Shabunda are forced to make regular sorties into the forest in order to gather food, each time risking abduction, rape or murder. "This morning," said MSF's Dr. Eric Laperriere-Nguyen, speaking at the end of January, "three women were abducted in the forest just outside town. Last month 40 women were seized in one incident, gang-raped and then released three days later. It happens all the time."

Therese's story is typical. She is 27 years old, and fled with her 18-month daughter Bijou into the forest when the fighting came to her town."Fifteen men with guns and bows and arrows surrounded us. We had to walk for three days through the jungle to the village that was the Mai Mai headquarters. I was there for three months - five men took me to be their 'wife' and their slave. I saw one woman killed because she refused; they cut off her breasts. My daughter died while we were there. We got home eventually. It's because of God that I'm alive. But no-one will want me now."

As well as the stigma of rape and the psychological scars, many of the women bear physical legacies. Sexually transmitted diseases (STD's) are common. "(In January) we went to the village of Matili, 34km south of Shabunda," explains Dr Eric. "It was the first time we'd been there for four months because of the insecurity. In Matili we treated some 250 women who had been raped. We treated all of them for STD's such as salpingitis, which causes pain, infertility and a foul-smelling discharge. But some of the women had been so badly damaged by the sexual assaults that they will require surgery."

This is a common problem. The violence of the sexual assaults and the lack of medical care have left some women suffering incontinence due to a fistula forming between the anus and the vagina. According to a local health worker, "There is no life for a woman with a fistula. The smell is so bad, they will not be accepted by society, maybe, just maybe, their mother will stand by them. But no one will want to approach them."

But there are no proper facilities for surgery in Shabunda - MSF's doctor Eric is the only doctor in the entire province, for a population of 570,000 people. "We arrange and pay for these women to fly to Bukavu for surgery," he explains." It can take several weeks, even months, before their surgery is complete. But it's all worth it when they come back healed, and so much happier."

MSF can treat the women's medical problems but the psychological and social fallout from the assaults need a different approach. Rape survivors often face rejection and social stigma. Even if their husband lets them return home, it is normal for him to find a new wife, moving the old one into a different room and ignoring her. Fear of disease, real or perceived, is often given as the reason for this rejection.

A group of brave local women have formed a Women's Association, AMACUS, to provide support to the rape survivors and to break the taboos surrounding their experiences. MSF works closely with AMACUS and local missionaries to spread the word about MSF's free treatment and encourage women to seek help. Some are courageous enough to talk to outsiders.

"You can't keep a secret like this because this was something where we were openly violated, we were raped in front of our children," says one survivor. "I will not be ashamed or keep a secret of how they raped me and ripped my genitals all the way to the back. I'm not healed, I'm hurting. I'm not going to hide it."

There is now a joint effort to find practical ways to reduce the vulnerability of these women to attack. Small market gardens have been planted close to town so they can avoid the dangerous foraging trips into the forest. The first harvest is due this spring.

But these are short-term measures, akin, according to Dr. Eric, to -sticking a plaster on a gaping wound'. There are thousands of people who are in danger every day in eastern Congo - if not from armed men, then from hunger, disease or lack of access to health care. In the end, the biggest enemy of the women of Shabunda may not in fact be the Mai Mai. It is the crushing poverty brought about by war that drives women to risk their lives for a sack of cassava root.