Trigger Warning: This article includes references, graphics, images, and pieces of texts about sexual violence, rape and trauma. Definitions of conflict-related sexual violence and international’s responses are discussed. Some might find it distressing.
In April 2022, the world woke up to a picture of the bodies of a naked man and some women partially burned on the roadside of a highway 20km outside the capital Kyiv, Ukraine. This distressing image, taken by the photographer Mikhail Palinchak, contributed to the mounting evidence of executions, rape, and torture that had been used against civilians since the initiation of the invasion of Ukraine.
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I am a Core Trainee Psychiatrist, passionately advocating for human rights and mental health. I am part of the executive committee for the Royal College of Psychiatrists’ Women’s Mental Health Special Interests Group. I am a leader of Geopsychiatry, an NGO (non-governmental organisation) which studies the impact of war conflict, climate change, public health issues, globalisation, and foreign policy on mental health. I have written articles, such as the need for women's leadership in the UN, and how COVID-19 unmasked the ongoing pandemic of gender-based violence. Similarly, I have written a blog titled, “Mental health of women and children in conflict zones: Their bodies and health are the battlefields of war”.
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As Christina Lamb says in her book Our Bodies, Their Battlefield: Through the Lives of Women, “Rape, is “the cheapest weapon [of war] known to man”, aiming to intimidate, degrade, and put fear into individuals and communities. This is often a planned, intended outcome of sexual violence, and in some cultures, it ensures that victims are rejected by their families and socially shamed.
It is also a method of “ethnic cleansing, as it is deployed as strategically and deliberately as one would with bombs and bullets. Laura Shepherd also highlighted in her book Gender Matters in Gender Politics, that mass rape is the most common type of rape associated with war, usually committed in public. The perpetrators are usually men, soldiers or citizens, and the sexually violent act can be part of a military and/or political strategy.
For example, rape camps were set up by Serbian soldiers during the Balkan wars, where victims were raped and forced to bear Serbian babies. In Iraq, ISIS sexually enslaved and trafficked women from the Yazidi minority as part of a campaign to destroy the community, fully acknowledging that children born of rape would be deemed Muslims and not Yazidi.
Ukraine’s human rights ombudsman, Lyudmyla Denisova, has already collected several cases of sexual violence by Russian soldiers. In one case, 25 girls and women (aged 14 to 24) had been held in a basement by Russian soldiers. The soldiers threatened to “rape them to the point where they wouldn’t want sexual contact with any man, and to prevent them from having Ukrainian children”; reports from Bucha say 9 of them are now pregnant.
Meanwhile, Ukrainian children from occupied cities are being forcibly fast-tracked for adoption by Russian families across the border. This will make it harder for Ukrainian families to track these children in the post-war future, especially when they grow up and forget their birth parents and heritage. This systematic propaganda aims to eradicate the very idea of being Ukrainian.
Rape methodology has always been used in wars, even in ancient times. What’s shocking is that it still prevails.
The United Nations (UN) Secretary, General Antonio Guterres, and the International Criminal Court have stated that conflict-related sexual violence is widely recognised as a war crime, that is preventable and punishable. These crimes and the perpetrators rightly deserve prosecution under International Criminal Law. However, threats of criminal accountability on an international level may preclude peaceful settlement, therefore making it harder to eliminate sexual violence in conflict.
Terminology
The term “conflict-related sexual violence” refers to rape, sexual slavery, forced pregnancy, forced abortion, enforced sterilization, forced marriage, and any other form of sexual violence of comparable gravity perpetrated against women, men, girls, or boys that is directly or indirectly linked to a conflict. Women are either killed or die of their wounds shortly after being raped, including the presence of HIV/AIDS increasing the chances that women will die consequently.
Sexual violence is a serious violation of human rights—a problem of legal, social, and a public health concern. It is considered one of the worst traumas experienced by a person. What doesn’t result in death, predisposes the victim to acute and chronic mental illness, as well as other comorbidities and repercussions on physical health and mortality.
Sex traffickers are preying on vulnerable women and girls on the borders between Ukraine and neighbouring countries. This is a form of slavery, and the mental and physical health effects of sex trafficking are dire. The UN had even asked the British government to ban single men from housing female refugees, as the unguarded moments for women and children are providing opportunities to those who seek to exploit them.
How did the world respond to these grievous horrors?
Over the centuries, laws and customs of war have navigated a broader understanding of sexual violence, the impacts and the need to protect potential victims. After World War I, the War Crimes Commission was established, and forced prostitution and rape were seen as a grave violation of the laws and customs of war. After World War II, under the International Military Tribunal at Nuremberg (IMT) and the International Military Tribunal for the Far East at Tokyo (IMTFE), the spectrum of sexual violence as a “war crime” was widened. However, rape was not explicitly mentioned in final verdicts. The trauma and violent acts towards these victims were not being acknowledged in these rulings; the victims felt ignored and shamed.
In 2014, then UK Foreign Secretary William Hague and Special Envoy of the UN High Commission on Refugees Angelina Jolie hosted the Global Summit on Sexual Violence in Conflict. Hague stated that sexual violence in conflict is “the slave trade of our generation”; Jolie declared that sexual violence victims are “the forgotten victims of war; responsible for none of the harm, but bearing the worst of the pain”. Although women are generally thought of as victims of sexual violence in conflict, we should acknowledge that rape and sexual violence are used against women, girls, men and boys.
In April 2019, the UN Security Council, via the adoption of resolution 2467, recognised the need for a survivor-centred approach to prevent and address sexual violence in conflict and post-conflict situations. Subsequently, the UN released the 11th annual report on Conflict-Related Sexual Violence, which spanned 19 countries covering the period of January to December 2019. Focusing on sexual violence as both a tactic of war and terrorism, the report calls for the reinforcement of a vision based on empowering women as agents for change, as well as amplifying the voices of survivors.
For example, The UN Assistance Mission in Afghanistan (UNAMA) documented 102 cases of sexual violence — women, girls and 13 boys –attributed to members of the Taliban, Afghan National Defence and Security Forces, and a pro-government militia. During the 6-years of civil war in Yemen, many women have faced high levels of male violence, as armed men take advantage of the lck of security and lack of safe spaces for the vulnerable 83% of displaced women and children.
On 13th April 2022, Lord Tariq Ahmed of Wimbledon debated at the UN Security Council on ending the perpetuating cycles of sexual violence in war conflicts — highlighting that impunity is still continuing as a norm for the perpetrators. Simultaneously, he stated that the UK has launched the Murad Code, a global code of conduct, to be used for the collection of information and evidence from survivors of conflict-related sexual violence. The code is named after Nadia Murad, the Nobel peace prize-winning Yazidi woman who survived capture by ISIS, and is hoped to become “the gold standard for any Non-Governmental Organization (NGO), government agency or human rights institution in the field”. By putting the survivors at the heart of the investigations, hopefully this would strengthen international actions and call for criminal prosecutions against the perpetrators.
Proposed actions to help the victims of sexual violence
A number of mental disorders are associated with sexual violence. The long-lasting consequences, such as physical injury, mental health deterioration, and social stigma place survivors of sexual violence at significantly high risk of adversities.
Female refugees and immigrants are more likely to show higher levels of fear, more isolation, have greater trauma and have more mental health needs than other victims of crime. They may also misuse alcohol or drugs to cope with their situation. Their health needs span is associated with Sexual Transmitted Infections (STIs), pregnancy, injuries from physical and sexual assault, suicidality and other behavioural problems. Along with these challenges, female refugees and immigrants may remain silent, due to threats or fears of being deported or losing custody of their children.
Primary care practitioners can play a key role in the recognition and management of mental disorders in immigrants and refugees, as they under-utilize formal mental health services. An integrated treatment approach is often required for extreme traumas, such as torture and rape. Clinicians should be alert for unexplained physical complaints, sleep disorders, panic disorder and somatoform disorder, severe dissociation mimicking brief reactive psychosis, and psychotic depression. Key elements to look out for include the level of psychological distress, the impairment associated with the symptoms for the patient and her family, substance abuse and suicidality.
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Rape constitutes the worst harm in war due to the shame it brings to both the individuals and the communities. Shame might thrive on silence, but it also thrives on narratives that make certain acts or experiences shameful.
It should be recognised that current international accountability and deterrence isn’t doing enough. Eradication of sexual violence should be seen as an achievable goal, and considered a priority by feminists and society at large.
Perpetrators and “monstrous leadership” must be held accountable and be prosecuted. Otherwise, the hurt and damage of war will forever live through the civilians and communities deeply affected.