Central African Republic

Situation Report
The mixed Congolese and Central African surgical team performing its first fistula surgery at the Hôpital de l’Amitié in Bangui. ©Mukwege Foundation, 2020.
The mixed Congolese and Central African surgical team performing its first fistula surgery at the hôpital de l’Amitié in Bangui. ©Mukwege Foundation, 2020.

Holistic care for survivors of sexual violence in the Central African Republic

The inauguration of the project Nengo on the eve of the first day of «16 days of activism to end gender-based violence» in Bangui could not have been timelier. «Nengo» in the local language Sango means dignity. And dignity is what the project aims to restore for thousands of women and girls, but also boys and men who survived violence directed at them based on their gender.

One of the country’s darkest chapters

Every single hour in the Central African Republic, a case of gender-based violence is reported. And the situation is certainly worse, since the respective information management system (GBVIMS) supported by humanitarians covers only 42 per cent of the country. Widespread insecurity in the country maintains a context conducive to gender-based violence, but also deeply rooted gender inequalities, the abuse of power and harmful norms contribute to this crime. The COVID-19 pandemic has further increased existing vulnerabilities, particularly during its first months. As lives retreated inside homes due to lockdown measures introduced by the government, an alarming increase in violence against women and girls was reported in the Central African Republic. Women and girls had to stay at home with their abusers – often spouses, partners or family members – increasing cases of violence by at least by 10 per cent, while limiting survivors’ possibilities to seek protection and assistance.

Project Nengo sets up a centre for the holistic care of victims within a public hospital in Bangui, the Hôpital de l’Amitié, and within the Central African Women Lawyers Association, two recognised referral centres for survivors of sexual and gender-based violence in the country. After months of preparation, teams from the gynaecology-obstetrics and maternity department at the Hhôpital de l’Amitié and the Women Lawyers Association, with the support of international partners, launched the holistic care programme for survivors of sexual violence.

A «one stop centre» to rebuild lives

The newly established centre provides a single point of reference, a «one stop centre» for survivors of sexual and gender-based violence to receive a comprehensive response to their needs. This holistic care model was developed by 2018 Nobel Peace Prize laureate Dr Denis Mukwege and his team at the Panzi hospital in Bukavu in the eastern Democratic Republic of Congo (DRC). It structures around four pillars, which respond to the essential healing needs of victims and their empowerment:

The response includes medical care and the treatment of severe gynaecological injuries, which may include surgery. Survivors often show signs of depression, fear, behavioural disorders and self-shame. They face social exclusion and troubles rebuilding trust and relationships. The second pillar of the response therefore centres on psychosocial care, an integral part of the healing process that both anticipates and complements physical treatment. The survivors also receive legal assistance to demand justice, including judicial counselling and an accompaniment throughout the judicial process. And fourth, survivors are empowered socio-economically, for example, through literacy training, small business management and microcredit programmes and scholarships. Economic reinsertion and rebuilding independent livelihoods are particularly important for those survivors whose subsistence depended on their aggressor.

Having all services united underneath one roof is practical for those seeking assistance and it makes referrals between services easier. But it is also an important component of victim protection. It avoids that the survivor has to tell her or his story over and over again, reliving the atrocities.

Project Nengo will also contribute to the prevention of sexual and gender-based violence in the Central African Republic through advocacy, strengthening of the rule of law and reducing structural causes of these types of violence by promoting gender equality.

South-south skills transfer

Faced with the grave situation in the Central African Republic, a consortium of four international institutions – the Pierre Fabre, Panzi DRC and Dr Denis Mukwege foundations and the Francophone Institute for Justice and Democracy – joined forces and with financial support from the French Agency for Development, replicate Dr Mukwege's holistic care model from the DRC in Bangui.

The «one stop» model for survivors of sexual and gender-based violence is also being replicated in other countries, including Guinea, Colombia and Uganda. The transfer of skills between Congolese and Central African actors will strengthen the capacities of the public hospital and the local lawyers association for the benefit of people in the long run. Improving the quality of care in the gynaecological-obstetrics department of the hospital will moreover benefit the entire population and not only survivors of violence.

Beyond the capital

Over 3,000 survivors will be able to receive treatment and support at the new centre over the course of the next four years. Although located in Bangui, the centre will also be accessible for survivors from outside the capital through a referral system between the Nengo project and NGOs, health care providers and civil society organizations located throughout the country.

On the eve of project Nengo’s inauguration, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) intervened at the project's Strategic Steering Committee workshop to present mechanisms for the prevention of sexual abuse and exploitation within the humanitarian community, and will continue to bridge the project with humanitarian actors working in the areas of protection, health care and empowerment.