Sexual violence toward children and youth in war-torn eastern Democratic Republic of Congo

Abstract

Background: The epidemic of gender-based violence in the Democratic Republic of the Congo (DRC) has garnered popular media attention, but is incompletely described in the medical literature to date. In particular, the relative importance of militarized compared to civilian rape and the impact on vulnerable populations merits further study. We describe a retrospective case series of sexual abuse among children and youth in eastern DRC.

Methods: Medical records of patients treated for sexual assault at HEAL Africa Hospital, Goma, DRC between 2006 and 2008 were reviewed. Information extracted from the chart record was summarized using descriptive statistics, with comparative statistics to examine differences between pediatric (≤ 18 yrs) and adult patients.

Findings: 440 pediatric and 54 adult sexual abuse cases were identified. Children and youth were more often assaulted by someone known to the family (74% vs 30%, OR 6.7 [95%CI 3.6-12], p<0.001), and less frequently by military personnel (13% vs 48%, OR 0.14 [95%CI 0.075-0.26], p<0.001). Delayed presentation for medical care (>72 hours after the assault) was more common in pediatric patients (53% vs 33%, OR 2.2 [95%CI 1.2-4.0], p = 0.007). Physical signs of sexual abuse, including lesions of the posterior fourchette, hymeneal tears, and anal lesions, were more commonly observed in children and youth (84% vs 69%, OR 2.3 [95%CI 1.3-4.4], p = 0.006). Nine (2.9%) pediatrics patients were HIV-positive at presentation, compared to 5.3% of adults (p = 0.34).

Interpretation: World media attention has focused on violent rape as a weapon of war in the DRC. Our data highlight some neglected but important and distinct aspects of the ongoing epidemic of sexual violence: sexual abuse of children and youth.

Figure 1. Characteristics of sexual assault according to patient age.

A.The largest number of cases in our retrospective sample from a single centre between 2006 and 2009 was in the age group 10–18 years. B. The proportion of cases allegedly perpetrated by military personnel was significantly higher in adult compared to pediatric rape victims (p<0.001). C. Delayed (>72hours) presentation was more common in youth aged 10–18 years than adults and younger children. D. Genital injury was more commonly observed on physical examination at presentation in youth aged 10–18 years than adults and younger children.