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International Day of Action Against Violence Against Women


THE LANCET, Volume 354, 11 December, 1999 Breaking the silence surrounding rape

Nov 25 was International Day Against Violence Against Women. It was marked by various activities worldwide, and was the first day of the "Take a Stand" movement in South Africa. Take a Stand, which involves peaceful protests and poster campaigns, was launched by a coalition of organisations, including women's groups, churches, businesses, and trades unions, that are speaking out against all forms of sexual violence. The campaign follows months of sustained news coverage of rape, after the conference of South African editors made a commitment to ensure that sexual violence is covered prominently in all types of media. The action was prompted by the public outcry after the brutal gang-rape and murder of a 14-year-old girl in Cape Town earlier this year. South Africa has the unhappy distinction of being known as the country with the highest incidence of rape worldwide. Estimates vary as to the extent of this violence, but all agree that it is astonishingly prevalent. For example, the National Institute for Crime and the Rehabilitation of Offenders estimates that a woman is raped every 83 s in South Africa.1 As Carol Bower, director of Rape Crisis Cape Town has commented: "South Africa is a society at war with its women". But in other regions of the world where society has completely broken down, rape, mainly of women, is an integral part of war. Rape and sexual assault have always been used as weapons of war but this aspect of the history of conflict has not been accorded a high profile. There are many reasons for this silence, including difficulty in quantifying the extent of such violence, but it is not unreasonable to suspect that a major reason has been that rape in war has been considered insignificant. Indeed, it is only in recent years that sexual atrocities committed during armed conflict have been brought to the attention of the general public, largely as a result of advances in communication technology. Media coverage of the use of rape in the wars in Bosnia and Rwanda made such atrocities difficult to ignore. Nevertheless, it took persistent pressure from non-governmental organisations to ensure that sexual violence was considered by the bodies investigating the genocide.2 In the wake of these atrocities, much has been written about how rape is used to undermine and humiliate the enemy in conflict situations, but, as the late human-rights activist André Sibomana noted, the violence in Rwanda was not even limited to the opposing side. "FAR [the Rwandan Armed Forces] soldiers and interahamwe militia carried out rape on a large scale. For some, it was part of a political strategy: rape was one more step in the process of humiliating a Tutsi family. Many women were raped in front of their family, then killed with them. But for most of the perpetrators, I think it was just another form of delinquency, like theft or looting. Because it was not only Tutsi women who were victims of rape; many young Hutu women were also subjected to this violence."3

The horrors in Bosnia and Rwanda have nevertheless marked a turning point in how war rape is viewed. In 1996, sexual assault was cited as a crime against humanity for the first time, by the International Criminal Tribunal for the former Yugoslavia. And in 1998, the International Tribunal for Rwanda found Jean-Paul Akayesu guilty of genocide and crimes against humanity; for the first time, an international court found rape to be an act of genocide.4 There are signs, therefore, that rape, whether during wartime or not, is starting to be taken seriously by the international community. At a forum in London, UK, on Nov 25, organised by the women's human-rights charity, WOMANKIND Worldwide, speakers who have helped women who have been raped in conflict and non-conflict situations described the enormous difficulties they face in working on prevention in general and in providing aid to women who have been sexually assaulted. Participants from various countries spoke of the need to change attitudes in order to prevent rape and of the failings in many legal systems that discourage women from pursuing legal action. The difficulties are compounded by the silence surrounding rape. In many cultures, women who have been raped stay silent because to speak out would result in their being ostracised by their community and losing their families or being unable to marry. Seemingly irrational, yet very common, feelings of culpability and shame also prevent women from seeking the support they need.

Such support obviously includes medical aid, and it is timely to reflect on whether the medical community is doing enough to lend its voice to those who abhor sexual violence and to provide sensitive and appropriate help to women who have been assaulted. Although some countries' medical associations have issued guidelines to clinicians, little work seems to have been done in assessing the standard of care provided for women who have been raped. Thus initiatives, such as that of WHO to investigate domestic violence against women, described by Claudia Garcia Moreno in today's Lancet , are welcome.

Nevertheless, there is much work ahead for the medical community in tackling these forms of violence now that the prevalence is finally starting to be acknowledged. Sarah Ramsay

The Lancet, London WC1X 8RR, UK

An Overview of Rape in South Africa - Mary Robertson

South Africa has one of the highest rape statistics in the world. In 1988, a total of 19 308 cases of rape were reported to the South African Police Service (SAPS). In 1994, this figure increased to 42 429 reported cases of rape. In 1996, 50 481 cases of rape were reported to the SAPS.

According to the National Institute for Crime Prevention and Rehabilitation (NICRO), the situation is more serious. NICRO has estimated that only one in twenty rapes are reported to the police. On the basis of this estimate,it is calculated that one rape occurs every 83 seconds.The SAPS has recently presented an even bleaker picture and they have suggested that one rape occurs every 35 seconds. Causes Various explanations have been proposed to explain what factors may contribute to the high incidence of rape in South Africa. These include: · Sociological explanations which locate the roots of rape in male and female roles in our society. South Africa is traditionally a male dominated and patriarchal society. Women hold limited power and authority and are frequently exploited. Research suggests that rape is more prevalent in such societies.

· Societal attitudes may contribute to rape. Rape is more common in societies which accept and believe in the "rape myths". These myths are false ideas about what rape is and include beliefs such as: men rape because they cannot control their sexual lust, women encourage rape, rapists are strangers and women enjoy being raped. These myths serve to label women as in some way responsible for the rape and to view men's actions as excusable, thereby giving silent consent to their actions. These rape myths also reduce the likelihood of women reporting their rape, for fear of being blamed and stigmatised.

· A "culture of violence" has dominated South African society for years.Our current levels of criminal and political violence has it's roots in apartheid and political struggle.The ongoing struggle and transition has left many men with a sense of powerlessness and perceived emasculation.

Studies suggest that the majority of perpetrators of violence are male and the victims are frequently women and children. This may represent a displacement of aggression in which men of all races feel able to reassert their power and dominance against the perceived "weaker" individuals in society. In this context, rape is an assertion of power and aggression in an attempt to reassert the rapist's masculinity. ·

Inadequacies in our criminal justice system create an environment where it is relatively easy to commit an offence of rape without any severe consequences. Rape has one of the lowest conviction rates of all serious crimes in South Africa. Offenders frequently evade arrest and conviction and continue to intimidate their victims and the victims family. In the absence of effective witness protection services, women often withdraw or fail to report cases as they fear intimidation by the perpetrator. Sentencing tends to be lenient which creates an impression that rape is not seen as a serious crime.

Impact of rape

Rape is one of the most devastating personal traumas. Many victims feel as if there lives have been shattered and that their psychological and physical privacy has been invaded. The emotional scars can take months and sometimes years to heal. Typical reactions following a rape include feelings of shock, disbelief, numbness, fear, anger, guilt, self blame, sadness and sometimes elation.

Changes in behaviour are common such as withdrawal, sleep disturbances, hypervigilance mood swings, poor concentration, lifestyle changes and avoidance . These rape trauma reactions are similar to post traumatic stress reactions but symptoms such as avoiding men, sexual difficulties, feeling ashamed and dirty, are specific to the nature of the crime. Contrary to popular belief, the majority of rapists are known to the victim.

In these situations, the survivor may blame herself for somehow encouraging the assault. Frequently, the victim's own sense of shame and stigma is exacerbated by the judgemental reactions of others. It is ironic that at the time when support is most needed, many rape survivors feel alone and let down by loved ones, friends and institutions that are there to protect and support them. Caregivers need to offer the victim support and reassurance and to educate and support the family to help facilitate the recovery of the survivor. It is advisable to refer the victim for trauma counselling if these services are available. Through counselling, the victim can work through the experience and begin to view herself as a survivor who can still lead a happy and independent life.

Secondary victimisation

Sensitive and empathic management by caregivers often helps the victim feel validated, understood and cared for. Unfortunately, many rape survivors undergo "secondary traumatisation" when caregivers, police and others to whom the trauma survivor turns for emotional, legal, financial, medical or other assistance respond in a negative or insensitive manner. Many rape victims perceive this secondary trauma as worse than the rape itself as it leaves them feeling betrayed by those that are designated "caregivers" in society.

This insensitivity may be due a lack of training and awareness. In addition many of our police, medical personnel and court officials are overworked, burnt out and emotionally depleted which makes it difficult to respond with empathy to the rape victim. The caregiver may see the survivor as just another complainant/ patient. However, for the victim, this may be the most devastating and crucial moment in her life. It is essential that caregivers remain sensitive to the needs of the victim and are aware of their own beliefs and attitudes which may impact on the management of the victim. This will reduce the level of secondary traumatisation and will help to ease the suffering of the numerous South African women who have lived through the horror of rape.


Lewis S. (1994) Dealing with Rape. Johannesburg:Sached Books.
Mastakis, A. (1992) I Can't Get Over It. A Handbook for Trauma Survivors. Oakland, New Harbinger Publications.
Vetten. L. Roots of a Rape Crisis. Crime and Conflict 1997; 8:9-13.

Mary Robertson is Coordinator of The Trauma Clinic at the Centre for the Study of Violence and Reconciliation.
In Continuing Medical Education Journal, February 1998.

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