Our dear friend and medical partner Dr. Denis Mukwege of the Democratic Republic of the Congo (DRC) was announced the winner of the Sakharov Prize from the European Parliament earlier this week, representing another well-deserved accolade for this courageous surgeon who has treated thousands of survivors of sexual violence in his country. This award will also likely draw renewed attention to the struggle against widespread sexual violence in the DRC and the need to end rape in conflict globally.

There is special poignancy in this award, which is named after another bold scientist who took great personal and professional risks to speak for silenced and persecuted individuals in the Soviet Union. Like Dr. Mukwege, Andrei Sakharov could justifiably have solely focused his work on nuclear physics. Instead, he utilized this expertise to warn about the dangers of proliferation and his own country’s development of weapons of mass destruction, and became an outspoken dissident defending thousands of prisoners of conscience. In speaking truth from their respective scientific endeavors, both Sakharov and Mukwege became seized with the underlying human rights challenges facing their societies. They channeled their eloquent voices to the global causes of human rights and justice. While working doggedly to end violence and oppression in their own countries, they also joined international movements for change, and lent their voices to campaigns for victims of violence thousands of miles away. Sakharov paid the price by spending years under house arrest and internal exile. Dr. Mukwege has endured a terrifying assassination attempt and continued insecurity.

But just like Sakharov, Dr. Mukwege will not be silenced, and as his work becomes more widely recognized and lauded, even those who seek to muzzle his voice may come to view him as a national treasure.

Two weeks ago, my colleague, Karen Naimer, and I joined colleagues of Physicians for Human Rights at Panzi Hospital in Bukavu, where – under Dr. Mukwege’s leadership – survivors of rape, including new cases of very young children, receive medical care, counseling, and services to support their access to justice. The setting with courtyards and gardens seems like a haven from the brutal conflicts surrounding them in this war-ravaged part of eastern DRC.

The presence of a new medical examination room specially designed for children, a state-of the-art CT scanner that can help document internal injuries, and an impressive new facility for training women in business skills and psycho-social recovery all demonstrated the vision of this pioneering doctor and his growing staff of trained surgeons, gynecologists, nurses, and social workers whom we are so privileged to partner with. Panzi Hospital’s holistic approach can serve as a model not only for the DRC, but for care and prevention of sexual violence globally.

But Dr. Mukwege will be the first to acknowledge that we have only just begun the monumental effort to prevent the brutal sexual violence that tears apart communities, destroys bodies and minds, and continues with impunity in so many corners of the globe. As he has stated over and over, medical care for victims of rape must be accompanied by justice and peacebuilding and a commitment to ending the shame, stigma, and social ostracism resulting from this horrific violation. And the underlying causes of the violence, including endemic gender inequalities and discrimination as well as unchecked militarization, are areas that physicians like Dr. Mukwege recognize they must also speak to as part of their professional obligations to support the health and well-being of their communities. This prize recognizes not just Dr. Mukwege’s daily work to heal survivors, but also his tireless efforts to deepen and widen the conversation and prevent sexual violence in the future.

Congratulations, Dr. Mukwege.

It was foreseeable that if an Ebola outbreak in an impoverished African country moved from rural to urban areas, the existing heath care systems would be unable to treat everyone or prevent further transmissions. Years of conflict, lack of education, corruption, distrust of government, and chronic underinvestment in the health care system would take their toll.

People in West Africa are dying of poverty and the Ebola virus is the instrument of those deaths. While any outbreak of Ebola would lead to some deaths, there are steps that can be taken to stem the spread of the virus once its presence is identified. A robust response of the health care system acting in concert with strong public health policies and practices that are rooted in human rights principles can be effective in preventing further infections. Such a response must prioritize effective identification and treatment of people with the virus, contact mapping and monitoring of people who may have been exposed to it, accessible information campaigns, strong protections for health care workers, and measures to ensure that all people can access health care without discrimination. When such an outbreak occurs in countries that do not have adequate resources to undertake this response, including people with the proper expertise, the international community must provide assistance in a timely manner.

Given the lack of investment in the health care systems of the three hardest hit countries in West Africa (Liberia, Sierra Leone and Guinea) – investment that requires domestic political will and resources from the international community – the spread of Ebola was inevitable. Major missteps by the World Health Organization (WHO) and the delayed and frankly indifferent response of wealthier countries have exacerbated the situation. It is worth repeating: people in Liberia, Sierra Leone, and Guinea are dying of poverty.

The belated and parsimonious response of governments that could have acted sooner to provide much-needed expertise and resources reflects an apparent willingness to allow thousands of Africans to die – so long as the virus did not leave West Africa. Former UN Secretary General Kofi Annan articulated this critique when he described himself as “bitterly disappointed” with an international response that is lackluster at best and counter-productive at worst. The delay in responding to the outbreak has caused the death of thousands of people who could have been saved. Rather than prioritizing treating those who have Ebola and preventing further transmission, developed countries seem more concerned with preventing Ebola from spreading outside of West Africa.

In fact, most governments – with a couple of notable exceptions – were only spurred to take necessary action commensurate with the extent of the crisis when Ebola cases were identified in the Western world. Indeed, Cuba, a country that continues to suffer the effects of decades-old economic sanctions by the United States, has been a leader in responding to the crisis.

We have become too accustomed to living in a world where developed countries do their best to keep their walls up and outsiders at bay. But a virus is much more like freely-flowing capital – it can more easily cross borders and no walls can keep it out.

From this Ebola outbreak, the international community must learn that the only way to protect the right to health of the privileged is to invest in the right to health of all people. The price we are paying to learn this lesson – the deaths of thousands of West Africans – is already too high.

Kenyan President Uhuru Kenyatta traveled to the International Criminal Court (ICC) last week to appear before trial judges, who will decide whether to continue pursuing charges of crimes against humanity for his role in 2007 post-election violence in Kenya. Kenyatta, who faces charges for allegedly organizing rape, murder, and forced deportation against people in the Rift Valley, asked that the case be terminated for lack of evidence. However, the prosecution has accused the Kenyan government of intimidating witnesses and withholding incriminating phone and bank records, and called for an indefinite adjournment of the trial to provide time to obtain the records.

Advocates of the court perceive Kenyatta’s arrival in The Hague as underscoring the ICC’s legitimacy and a step toward international criminal accountability, as he is the first sitting head of state to face trial since the Nuremberg trials and to appear before the ICC. Some worry, however, that the Kenyan president has used the ICC indictment to rally domestic support, pointing to the fanfare that awaited Kenyatta when he returned to Kenya. Moreover, the possibility that the Kenyatta case may collapse because the government is withholding evidence raises questions regarding the court’s capacity to prosecute crimes without cooperation from national governments.

In addition to such concerns, the ICC has received a variety of criticism. The African Union, for example, has accused the court of anti-African bias. One of the most vocal critics is Ugandan President Yoweri Museveni, who charged the ICC with “shallowness” for pursuing the Kenya cases. “African leaders should review their relationships with the ICC during the next summit,” Museveni said at a celebration of Uganda’s independence. These critics highlight that all of the court’s nine investigations are in Africa. These criticisms are misguided, however, as they overlook the history of current ICC cases and the court’s jurisdiction.

According to the Rome Statute, the court can only investigate cases in which, (a) an alleged crime was committed by a citizen of a state party to the Rome Statute; (b) the crime took place on the territory of a state party or the state has otherwise accepted court jurisdiction; or (c) the UN Security Council has referred the situation to the prosecutor. Chief Prosecutor Fatou Bensouda said herself that the court is “not in Africa by choice.” In four of the nine countries with ICC investigations — Uganda, the Democratic Republic of the Congo, the Central African Republic, and Mali — the heads of states invited court intervention. In two others, Sudan and Libya, the UN Security Council referred the situation to the court. The ICC investigations in Kenya and Cote d’Ivoire are the only ones initiated by the ICC chief prosecutor.

Constraints on the court’s jurisdiction also explain the absence of investigations into alleged international crimes in conflict zones such as Syria, Iraq, and Palestine, which are not party to the Rome Statute and have not otherwise accepted ICC jurisdiction. Without a UN Security Council referral, the court cannot legally intervene in these situations. For example, in May 2014, China and Russia vetoed a referral of the situation in Syria to the court, a move criticized by Physicians for Human Rights (PHR), which has long called for Syria’s referral. Regarding Palestine, the territory’s position as a non-member observer state in the United Nations enables it to become party to the Rome Statute, but the Palestinian Authority has not yet signed the treaty – nor otherwise authorized the court’s jurisdiction.

By focusing only on prosecutions, critics of the court overlook the Trust Fund for Victims (TFV) – the court’s sister organization, which provides material, psychological, and physical support to victims of crimes under ICC jurisdiction, even before successful prosecutions. Though underfunded and reaching only a portion of victims, this assistance appeals to ideals of restorative justice, which aim to repair the harm suffered by victims, not just punish perpetrators. The TFV currently is providing assistance to more than 100,000 victims in Uganda and the Democratic Republic of the Congo, and plans to expand its assistance to Kenya and Cote d’Ivoire in 2014 and 2015. Completion of trials will also open up the possibility for reparations, in addition to assistance.

Trials at the ICC and assistance from TFV are important steps toward justice for victims of international crimes. For example, a PHR study about post-election violence in Kenya found an increase in sexual assaults during that time and is now pursuing a public interest lawsuit against the Kenyan government to seek justice for survivors. Comprehensive justice for these survivors would include direct assistance and prosecutions at the international, national, and local levels. Such prosecutions would end the culture of impunity that facilitates these crimes, strengthening justice at both the international and local levels.

UN High Commissioner for Human Rights Prince Zeid Ra’ad al-Hussein called on Iraq to ratify the Rome Statute, or to allow the International Criminal Court (ICC) to exert jurisdiction over the situation in Iraq, following the release of a UN report that detailed horrific crimes within its territory. The report detailed “staggering” human rights violations committed by the self-declared Islamic State (IS), also called ISIS or ISIL, and related groups, as well as crimes committed by the Iraqi government in its attempt to quell IS.

The High Commissioner’s advice should resonate with those in the Iraqi government who seek accountability for war crimes and crimes against humanity. The ICC was established for situations like this – when domestic judiciaries are unwilling or unable to properly address crimes against humanity, war crimes, or genocide within their territories. Authorizing the ICC to exert its jurisdiction over the situation in Iraq would send a strong signal that the international community prioritizes justice for heinous attacks on civilians, no matter who the perpetrator is.

However, ratifying the Rome Statute, or authorizing the ICC to exert its jurisdiction, may not be an easy task for the Iraqi government. In addition to crimes committed by IS, state actions, such as those detailed in the UN report, would come under investigation and perpetrators may face prosecution. Perhaps more disturbingly, the United States may seek to keep the ICC out of Iraq to avoid international scrutiny and potential prosecution of future U.S. military actions in the country. The U.S. government has warmed its relationship with the ICC over the past dozen years, assisting with cases to the extent possible under current U.S. law, but the United States may still seek to keep the court clear of its military and other officials.

The Iraqi government should immediately accept the ICC’s jurisdiction as it considers ratifying the Rome Statute, and the United States should become a full partner in accountability for international crimes in Iraq. U.S. hesitancy about the court should be replaced by full support for accountability mechanisms at all levels – local and international – to address the truly shocking crimes in Iraq. The United States can demonstrate its leadership in promoting justice for some of the world’s worst crimes by joining High Commissioner Zeid in calling on Iraq to accept the court’s jurisdiction.

When studying in Jordan last fall, I was stunned by the silence around sexual violence experienced by women in Syrian refugee camps. In Arab communities, where social stigma and family honor carry huge weight, consequences of sexual violence extend far beyond scarring psychological trauma to fear of alienation and even honor killing. Already traumatized by the realities of war and atrocities, unaddressed rape tears lives and families apart – stigmatized and silenced, survivors are left with no means of healing. Sexual violence in the context of war can leave an entire population voiceless, paralyzed, and fractured.

Much like patterns seen in Bosnia, the Democratic Republic of the Congo, and beyond, the self-declared Islamic State (IS), also called ISIS or ISIL, has been systematically utilizing sexual violence to terrorize and brutalize men, women, and children alike. In light of a fatwa declaring “sexual jihad,” rape and kidnapping have quickly escalated as a fear-mongering tactic in Iraq and Syria. As of August, the United Nations estimated that some 1,500 women and children may have been forced into sexual slavery by IS – some through the abduction and abuse of entire families.

Media focus on IS has hardly wavered since June as the group rapidly seized Iraqi cities – threatening, torturing, and killing countless civilians. More recently, the beheadings of journalists, aid workers, and civilians have dominated headlines and captivated public attention. Meanwhile, the strategic use of sexual violence has barely been covered. Though multiple reports indicate IS’s extensive use of sexual enslavement, the Western world has remained virtually silent on this particular war tactic. The Guardian has noted the “deafening silence” on these abuses even among the world’s feminists.

Obama’s brief mention of sexual violence in his speech on IS this September barely skimmed the surface of this major issue, placing his focus on U.S. military action rather than the broader humanitarian crisis at hand. Despite its ravaging and widespread repercussions, sexual violence is still considered a tangential women’s issue and is not given the same quantity or quality of coverage as recent beheadings or the debate over military intervention.

As the United States engages in military action in the Middle East, the American public must strive to understand the scope of sexual violence and the weight of its consequences, responding with the same outrage and empathy prompted by beheadings. If we are to curb violence in the region and pursue justice for survivors, increased international attention and media coverage on sexual violence are absolutely critical.

In a letter to governors of all 50 U.S. states, prominent leaders in the field of infectious disease and public health write to express their concern over decisions by Governor Chris Christie (NJ) and Governor Andrew Cuomo (NY), as well as other states following their lead, to impose a mandatory 21-day quarantine on all health care workers returning from West African countries where they were responding to an outbreak of Ebola. These six experts urge all governors to adopt procedures that are consistent with public health and human rights standards, and end policies that ultimately serve to spread misinformation and stigmatize health workers returning from affected countries.

The full letter can be read below.

October 29, 2014

Dear U.S. Governors,

We write to express our concern over decisions by Governor Chris Christie (NJ) and Governor Andrew Cuomo (NY), as well as other states following their lead, to impose a mandatory 21-day quarantine on all health care workers returning from West African countries where they were responding to an outbreak of Ebola. We urge all governors to adopt policies that are consistent with public health and human rights standards. To do otherwise contributes to misinformation and stigmatizes health workers returning from West Africa who worked in Ebola treatment centers. 

This imposition of mandatory quarantines contradicts scientific and epidemiological evidence on the virus and its transmission, as well as internationally agreed human rights standards for responding to such a crisis. First, it ignores well-established information on how the Ebola virus is spread; second, it reinforces misperceptions about Ebola; and, third, it violates human rights standards dictating when and how quarantines may be imposed in public health situations.

These policies also effectively punish the much-needed volunteer health professionals who are using their expertise to address what is undeniably a crisis in West Africa. It also discriminates against and stigmatizes health professionals who have worked internationally. Such policies are indefensible, and have the potential to deter qualified health workers from volunteering to travel to the region to help treat the sick and prevent further cases of the disease. If much needed resources, including health professionals, do not help bring the outbreak under control in West Africa, the virus is far more likely to spread, including to the United States.

We learned the hard way with HIV/AIDS that misinformation – particularly when disseminated by government officials through laws, policies, and practices – can undermine people’s faith in both the health care system and the government. Instead of imposing policies that pander to the panic and ill-informed fear mongers, the U.S. government, at every level, should be working in a coordinated manner to ensure that there is a strong public education campaign about Ebola.

Furthermore, states should implement systems and adopt protocols reflecting the recommendations outlined in the “Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure,” issued by the U.S. Centers for Disease 

Control and Prevention. Public health specialists have been working with Ebola outbreaks since 1976 and are well aware of how to manage the virus at an individual and community level. To disregard decades of experience and feed into the panic just because the virus has crossed the Atlantic is counterproductive and undermines best practices.

Again, we urge that all currently imposed quarantines be lifted and that no new quarantines be authorized.  

Sincerely,

Deborah D. Ascheim, MD
Board Chair, Physicians for Human Rights, New York, New York
Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York

James W. Curran, MD, MPH
Dean of Public Health, Rollins School of Public Health, Emory University, Atlanta, Georgia

Linda P. Fried, MD, MPH
Dean, Mailman School of Public Health, Senior Vice President, Columbia University Medical Center, DeLamar Professor of Public Health, Professor of Epidemiology and Medicine, New York, New York

Michael J. Klag, MD, MPH
Dean, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Professor Peter Piot, CMG, MD, PhD, DTM, FRCP, FMedSci
Director, London School of Hygiene & Tropical Medicine,
Former Executive Director, UNAIDS, London, United Kingdom

Paul Volberding, MD
Director of University of California, San Francisco AIDS Research Institute,
Director of Research for University of California, San Francisco Global Health Sciences, San Francisco, California

cc:

Karen DeSalvo, MD, MPH, MSc, Acting Assistant Secretary for Health in the U.S. Department of Health and Human Services
Tom Frieden, MD, MPH, Director, Centers for Disease Control and Prevention
Lisa Monaco, Assistant to the President for Homeland Security and Counterterrorism
Susan Rice, National Security Advisor

*Please send any responses or inquiries to Susannah Sirkin, director of international policy and partnerships at Physicians for Human Rights, at ssirkin@phrusa.org.

Pour lire cette page en français (pdf).

Sexual violence is a grave problem the world over, but it is particularly prevalent in conflict zones like the eastern region of the Democratic Republic of the Congo where I live and practice medicine. I frequently treat survivors of sexual violence, and many of my patients have been victims of this terrible crime on more than one occasion.

Technically, my job is to physically heal the survivors who make their way to our hospital. But these women, men, and even children need more than just medical treatment. They need justice. They need advocates who can stand up for them and say, “no more.”

As a physician, I want to be that advocate. I want to be that voice. I want to provide the evidence that will hold rapists accountable and send the message that these crimes will not be tolerated or ignored anymore. And now I have the key that will enable me to do just that.

This key is a mobile app called MediCapt created by Physicians for Human Rights. MediCapt allows clinicians like me to document evidence of sexual violence in a secure way and submit medical-legal proof to the justice system in real time. Using my smartphone, I can document evidence of the crime, including photographs, and then send the encrypted files to my colleagues in law enforcement and at the court who will prosecute the cases.

MediCapt allows me to play an important role in addressing crimes committed against my patients and assists the survivor in the healing process. This essential tool will help survivors regain their confidence, knowing that there is a medical-legal team working on their behalf.

I was fortunate to have been one of the physicians selected to pilot the app in my community, and I can already see the potential that MediCapt has for safely and securely documenting sexual violence and achieving justice for survivors.

I also had the honor of presenting the new app to an international audience at this year’s Global Summit to End Sexual Violence in Conflict in London. I was amazed by the incredible number of people who came from the around the world to combat this global problem. I told the crowd there that our whole team believes strongly that MediCapt will help us to address this scourge in our community. At the conference I saw that I must redouble my efforts – not only for the survivors I treat in my medical practice, but also for an international community that is working together to end sexual violence in conflict.