Background to the Conflict
The war which has spurred an increase in crimes of sexual violence against women in the eastern Congo is the local manifestation of a complex regional conflict which began in 1996 and has involved seven nations and many groups of armed combatants.
In 1994 the Rwandan government, dominant parts of its army (Forces Armées Rwandaises, FAR), and members of the Interahamwe7 militia directed a genocide against the Tutsi of Rwanda which took more than half a million lives. After being defeated by the Rwandan Patriotic Army (RPA), the military force of the Rwandan Patriotic Front (RPF), the government responsible for the genocide then led more than a million Hutu into exile in Congo, then Zaire, where civilian refugees and the military together established themselves in camps along the border. Under the direction of the defeated political and military leaders, soldiers and militia reorganized and rearmed within the refugee population, preparing for new attacks on Rwanda. Although such military activity was prohibited by international convention, neither U.N. agencies nor the larger international community intervened to halt the preparations.8
In late 1996 the Rwandan government sent its troops into the Congo, asserting the need to impede preparations for attacks on Rwanda as well as any obligation to protect the Banyamulenge, Congolese of the Tutsi ethnic group, who were being threatened by local and national Congolese political authorities. The Rwandan soldiers together with combatants of the Allied Democratic Forces for the Liberation of Congo (Alliance des Forces Démocratiques pour la Libération du Congo-Zaire, AFDL), a hastily organized coalition of Congolese forces, attacked the camps and killed tens of thousands of Rwandans, many of them unarmed civilian refugees. Hundreds of thousands of refugees then returned to Rwanda, some of them voluntarily, some of them forced to do so by Rwandan government troops. Some two hundred thousand Rwandans fled westward through the forests. Many of the civilians were massacred in the following months by RPA or AFDL troops but several thousand ex-FAR and militia members regrouped to resume fighting the Rwandan government forces in Congo and later in Rwanda.9
Uganda, too, sent troops to support the AFDL. Under the leadership of Laurent Kabila, the rebel force and its Rwandan and Ugandan allies marched on the Congolese capital, Kinshasa, and in May 1997 overthrew President Mobutu. Fourteen months later Laurent Kabila and his government sought to oust their foreign backers and Rwanda and Uganda then offered their support to a new rebellion against the Congolese government led by the RCD. To combat this alliance, President Kabila enlisted assistance, including troops and military aircraft from Zimbabwe, Angola, and Namibia.
This report deals only with territory under the control of Rwanda and RCD-Goma: RCD is used in this report to refer only to RCD-Goma although the RCD has undergone several divisions since its formation in 1998. RCD-Goma refers to the group based in Goma which controls most of North and South Kivu, parts of Maniema, Orientale, and Katanga, and a large part of Kasai Orientale provinces. RCD-Goma is widely described as proxy of the Rwandan government and dominated by forces of the Rwandan army which occupies this territory. The RCD-Goma is separate from both RCD-Kisangani and RCD-ML (RCD-Liberation Movement).
In July 1999 the main foreign contenders signed a cease-fire accord at Lusaka. But it was only in February 2001, after the assassination of Laurent Kabila and the installation of his son Joseph Kabila as president, that Ugandan and Rwandan troops and other foreign forces partially disengaged along the battlefront. 10 A United Nations peacekeeping force, the U.N. Observation Mission in the Congo (MONUC), was put in place to supervise the ceasefire and the demobilization of combatants. Namibia withdrew its troops and Uganda brought home some of its soldiers, although it later sent some troops back into the Congo. Zimbabwe, Burundi, and Rwanda said their troops would also be withdrawn, but fixed no date for this action.11 In October and November 2001 the Rwandan command shifted some of its troops to new posts in the eastern Congo.12
In the second half of 2001, there was little military activity on the front lines but combat continued in the Kivus, characterized by systematic and grave violations of international humanitarian law by all parties.13
The Lusaka agreement provides for an Inter-Congolese Dialogue to bring together representatives from the Congolese government, the rebel forces opposed to it, the unarmed political opposition, and civil society. After numerous postponements, the talks began in mid-October 2001 but quickly collapsed; they are finally took place in Sun City, South Africa, in early 2002. They led to a partial power-sharing agreement between the government of the Democratic Republic of Congo, the rebel MLC and most members of the unarmed opposition and civil society groups, but excluded the RCD and failed to secure peace with Rwanda.14
The Situation in the Kivus
The RCD claims to control a significant part of eastern Congo, including most of the provinces of North and South Kivu. It says it administers this area in accord with Congolese law and it has appointed governors and other administrative officials. But, in some areas, such as Shabunda territory, various local armed groups control most of the countryside and keep the RCD confined to the towns.
The Rwandan government, one of the original backers of the RCD and now its most important supporter, exercises considerable influence over its decisions. Rwanda has stationed thousands of troops in the Kivus and elsewhere in eastern Congo, claiming they are there to combat ex-FAR, Interahamwe, and others opposed to it. Rwanda draws enormous profit from the illegal exploitation of Congolese resources, providing another and perhaps more important motive for its determination to keep its forces on Congolese soil. A panel of experts appointed by the U.N. Security Council established in mid-2001 that Rwanda is growing rich at the expense of the Congo.15
In the southern part of South Kivu, the Burundian army also assists the RCD, though less extensively than does the RPA. Its soldiers are fighting along Lake Tanganyika against the Burundian rebel groups FDD and FNL which have bases on Congolese territory and which oppose the RCD. The Burundian government does not exert any significant political influence on the RCD nor has it engaged in significant exploitation of Congolese resources.
The Rwandan Patriotic Army originally was predominantly Tutsi; the number of Hutu in its ranks has increased considerably in recent years, but most high-ranking officers remain Tutsi. Similarly, Congolese of the Tutsi ethnic group - called Banyamulenge - play a major role in the RCD and Tutsi constitute the majority of officers of the Burundian forces. Congolese who are not Tutsi, particularly those opposed to the presence of Rwandan and Burundian government forces on their soil, often refer to members of any of these forces as "Tutsi," usually with negative connotations. In this report, we avoid such use unless directly quoting witnesses.
A number of armed groups made up primarily of Rwandan Hutu are fighting against the RCD, the RPA, and the Burundian army in the Kivus. Some of these combatants, particularly those in positions of command, participated in the Rwandan genocide, but many others-probably the majority-did not. Many persons, both Congolese and foreign, refer to these combatants globally as Interahamwe, a practice which wrongly attributes genocidal guilt to all. Some Congolese, whether Hutu or not, have also joined these groups In the remainder of this report, we avoid the term Interahamwe unless directly quoting witnesses.16
The main military force of Rwandan Hutu in eastern Congo is the Army for the Liberation of Rwanda (Armée pour la liberation du Rwanda, ALIR) which operates in North Kivu as ALIR I and in South Kivu as ALIR II. Other Rwandan Hutu combatants participate in the Democratic Forces for the Liberation of Rwanda (Forces démocratiques pour la liberation du Rwanda, FDLR), a group affiliated more closely with the Congolese army (Forces Armées Congolaises, FAC) and operating mostly in South Kivu and Katanga.17 Of an estimated 10,000 to 15,000 Rwandan Hutu rebels combatants in the Congo, perhaps half fight together with the FAC while the rest operate more or less autonomously in the Kivus in groups of varying size. Although ordinarily hostile to the RPA and RCD, some Hutu rebel groups are reported to have made short-term arrangements with them, particularly where necessary to facilitate exploitation of local mineral resources.
The FDD, a Burundian Hutu rebel group, has a strong presence in eastern Congo, mostly in South Kivu and Katanga provinces. Until recently they have been headquartered in Lubumbashi, from where its forces operated in conjunction with the FAC. It and the smaller FNL carry out military activities in South Kivu and from there across the border into Burundi.
Under Laurent Kabila, the Congolese government and army provided logistical and military support to rebel Rwandan Hutu and Burundian armed groups. When Joseph Kabila took power in early 2001, he promised to end this support, but reports in mid 2001 indicated that he had not yet done so.18
In January 2002, the new Burundian government-a broad-based government installed in November 2001 as part of the Arusha Peace Agreement-announced the withdrawal of its forces from Congo. In return, the Congolese government promised to stop supporting the FDD, thus appearing to acknowledge that the support continued at least until that time. As of this writing, Burundian government troops remained in Congo.
The term Mai-Mai19 originally applied to numerous locally based groups of combatants committed to the defense of their communities against outsiders, sometimes defined as Rwandan, Burundian, or Ugandan government soldiers, sometimes defined as Rwandan or Burundian rebel combatants, and sometimes defined as Congolese of other ethnic groups, particularly those who speak Kinyarwanda or are of Tutsi origin. For some Congolese the Mai-Mai represent "the popular resistance."20 A Congolese priest told our research team, "We are all Mai-Mai-it's self-defense. We must show the Rwandans that they control nothing."21 A doctor said, "The Mai-Mai are our colleagues. It's a popular revolution....They are the people of the village."22
During the course of the war, some Mai-Mai came to focus on increasing their own wealth and power in the name of defending their communities. They became opportunistic predators, killing, raping and pillaging local civilians. Some witnesses said this change resulted from intensified conflict with foreign troops over the control over local resources from which the Mai-Mai also intended to benefit.23 One Congolese human rights activist commented, "There are true and false Mai-Mai. True Mai-Mai are the ones who would not rape-they can't touch women. They have rules."24 Another activist explained, "When Kabila arrived with the Tutsi, bandits started invading the movement, taking advantage of opportunities presented by poverty and famine. [The Mai-Mai] became bandits because of a lack of structure."25 A Congolese lawyer concurred, "Mai-Mai have a certain philosophy. Others have rallied to the Mai-Mai but don't follow their principles and that leads to indiscipline." A thirty-two-year-old woman who was raped by three Mai-Mai was asked how she knew the perpetrators were Mai-Mai. "People recognized them. Everyone is Mai-Mai. At the beginning [of the conflict] they were good, but they became bad."26 Some Mai-Mai groups include Rwandan and Burundian Hutu.
Mai-Mai groups have no central command or uniform regulations. Some cooperate loosely with others, but many remain autonomous and sometimes even engage in combat with other Mai-Mai. Some Mai-Mai have allied with predominantly Hutu rebel groups, with the Congolese government, and even with Ugandan army forces and the RPA and RCD, often in short-term arrangements which can shift suddenly. The Congolese government reportedly tried to organize Mai-Mai forces under its control without success in-mid 2001. It is said to be continuing logistical and military support to some groups. 27
Socio-economic Conditions, Displacement and Health Care
The war has taken an enormous toll on ordinary people, costing the lives of 2.5 of the 20 million civilians in eastern Congo between 1998 and 2001, according to an estimate done by the International Rescue Committee. These deaths, estimated to be the number beyond that which would normally be expected for this population during this period, are more due to lack of food, clean water, medicine and shelter than to combat itself.28 Five years of war has virtually eliminated what remained of Congo's infrastructure after thirty years of mismanagement and erosion under Mobutu-its health, judicial and educational services, its road and communication networks. State employees, including health and judicial personnel, are unpaid and demoralized, unemployment is widespread, corruption has become necessary for most to survive, and, despite the country's enormous mineral wealth, the economy has collapsed.29 According to one study done in North Kivu, the majority of the people in that province lived on the equivalent of approximately U.S. $0.20 per day at the end of 2000.30
An estimated four-fifths of rural families have fled their homes at least once in the past five years.31 Some 760,000 people are currently displaced in North Kivu and 225,000 more in South Kivu, accounting for almost half of the whole country's total of 2,045,000 internally displaced persons.32 No longer within solid walls, sometimes living dispersed in the forest, displaced persons-particularly women and girls-had little protection if attacked by soldiers and combatants. Because farmers fled or were prevented from going to their fields or taking their produce to market, food production declined and malnutrition increased. According to aid workers who talked with Human Rights Watch researchers, malnutrition in one part of South Kivu was so serious in late 2001 that only adults were still able to walk to nutritional centers for assistance; children and the elderly lacked the strength to make the journey.33
Impoverished people rarely found the money needed to pay for health services. Even those with resources found the distance too great or the roads too insecure to go to a health center or clinic. In addition many health facilities no longer functioned because personnel had fled, because supplies were exhausted, or because the buildings had been damaged or destroyed. According to a report by the World Health Organization (WHO) and United Nations Children's Fund (UNICEF), more than 70 percent of the Congolese population is effectively without access to formal health care because they lack money for the services or because they cannot get to the facilities.34 About 1,837 women per 100,000 die in childbirth in Congo, over three times the average of other African nations.35
All parties to the conflict have targeted hospitals and health clinics, sometimes to pillage equipment and supplies and sometimes to punish staff for having supposedly aided their opponents or to prevent them from rendering such aid in the future.36 "We are between the hammer and the anvil," complained a nurse whose medical center had been attacked by RCD troops. The soldiers believed that the center had never been attacked by Hutu armed groups or Mai-Mai and that its staff must therefore be complicit with the rebels. In fact the soldiers were wrong. The center had been previously pillaged by one such group before it was attacked by the RCD forces.37
The Status of Women and Girls in Congolese Society
Even before the war in Congo, women and girls were second class citizens. The law as well as social norms defined the role of women and girls as subordinate to men. Although women are often a major-if not the major-source of support for the family, the Congolese Family Code requires them to obey their husbands who are recognized as the head of the household.38 Women and girls are also subordinate by custom and practice. A woman's status depends on being married and girls tend to marry at a young age. It is generally considered more important to educate boys than girls and a higher percentage of boys go to school than girls. Literacy statistics for Congo show how gender-specific discrimination was the norm before the war and continues to be a problem now.39 Male household heads often settle violent crimes against women and girls outside the courts. Some have "resolved" rape cases by accepting a money payment from the perpetrator or his family or by arranging to have the perpetrator marry the victim. Because of the number of cases settled in this way and because of the reluctance of women to suffer the stigma of being known as rape victims, the cases officially reported are certainly far below the number of crimes actually committed. Women and girls who are raped suffer significant loss of social status, as discussed below. In cases of the death of women and girls by murder or negligence, the family of the victim sometimes agrees to accept the equivalent of a woman's bride price as compensation and does not pursue the case further.40
Given their subordinate status, women find it difficult to protect themselves against sexually transmitted diseases, in particular HIV/AIDS. Women cannot require their husbands to use condoms, and, as in many countries, extramarital sex for husbands (but not wives) is tolerated. The very large families that are a norm in Congo, especially in rural areas, tend to limit women's options for independence from their husbands.
Outside the family, women likewise have limited power. Few Congolese women are in positions of leadership in civil society or in the political sphere. Although some effort was made to include women in the Inter-Congolese Dialogue, the vast majority of delegates are men.
Poverty and Survival Sex
The war has exhausted the reserves of the people of eastern Congo. The burden of trying to survive and assure that others in the family survive falls heavily on women. As the socio-economic situation worsens, more women and girls are resorting to trading sex for food, shelter, or money in order to provide for themselves and their families.41
Survival sex is different from the crimes of sexual violence committed by soldiers and combatants. But survival sex creates a context in which abusive sexual relationships are more accepted, and in which many men-whether civilian or combatant-regard sex as a "service" easy to get with the use of pressure.
Catherine B.,42 a thirty-year-old widow and mother of eight, explained: "I do not dare to refuse men because I do not want to leave the children hungry."43 In other cases girls without money for school fees have sex with their teachers in order to stay in school, or employees have sex with their employers in order to keep their jobs.44 Sometimes women and girls in these situations are raped, but often they accept the sexual relationship reluctantly as a way of surviving. A woman who works for an organization for "girls in unfortunate circumstances" told us, "The war has pushed the girls to prostitution."45 A U.N. official concurred. "We have come to the point where families even push their daughters into prostitution for simple survival," she said.46 One woman said that she had no choice but to accept men who might leave her a bit of money, "for example 100 francs" ($.30), because she does not want her children to go hungry.47
The exchange of sex for the necessities of life is apparently contributing to the spread of HIV/AIDS. "For a little money, for a little food, women give in," commented one doctor working in Goma.48 As women and girls cannot insist that men use condoms, the risk of their contracting and passing on the HIV virus is increased dramatically.
Because of the circumstances and the frequency of their contacts with men outside their households, women and girls who engage in survival sex are at high risk of rape. One woman explained: "I have to keep doing bad things like sleeping with men to stay alive. You have to submit to everything they do, get slapped around, and then we're badly paid too."49
Many women living in RCD military camps, including widows of soldiers and women whose husbands are missing or away on duty, suffer sexual harassment and rape by soldiers and officers. They are sometimes forced to trade sex for being allowed to continue living in the camp. Some of these women also brew and sell alcoholic beverages to earn a small income. Soldiers who come to drink sometimes refuse to pay and sometimes rape the women. One widow served local beer to five RPA soldiers in March 2001. They refused to pay her and then raped her in front of her children.50 One eighteen-year-old orphan who cares for younger brothers and sisters lives in a wrecked automobile on the grounds of a military camp. A local women's activist reported that she had sex with men who threatened otherwise to get her expelled from her shelter and the camp, and has been raped regularly by a RCD lieutenant who has a position of command at the camp.51
7 The Interahamwe (meaning literally "those who stand or attack together" in Kinyarwanda) officially referred to the youth wing of the former ruling party, the Mouvement Republicain Nationale Démocratique (MRND), but it came to describe all militia participating in the genocide regardless of party affiliation. See Human Rights Watch/ Fédération Internationale des Ligues des Droits de l'Homme, Leave None to Tell the Story: Genocide in Rwanda (New York: Human Rights Watch/ Fédération Internationale des Ligues des Droits de l'Homme, 1999), and see Human Rights Watch, Shattered Lives. Sexual Violence during the Rwandan Genocide and its Aftermath (New York: Human Rights Watch, 1996).
8 Human Rights Watch, "Rearming with Impunity," A Human Rights Watch Report, vol. 7, no. 4 , May 1995.
9 See Human Rights Watch, "What Kabila is Hiding, Civilian Killings and Impunity in Congo," A Human Rights Watch Report, vol. 9, no. 5(A), October, 1997 and Human Rights Watch, "Uncertain Course: Transition and Human Rights Violations in the Congo," A Human Rights Watch Report, vol. 9, no. 9(A), December, 1997 (both also available in French and available on the Human Rights Watch web site: http://www.hrw.org). To date no action has been taken to bring those who massacred the refugees to justice. The U.N. has made two efforts to document these war crimes but has failed to complete their work. After a team of experts appointed by the Secretary-General delivered a report on June 30, 1998 to the Security Council implicating Congolese and Rwandan soldiers in crimes against humanity against and possible genocide of displaced Rwandans, the U.N. Security Council charged the Congolese and Rwandan governments with carrying forward the investigation (see Presidential Statement dated July 13, 1998 S/PRST/1998/20). Neither has done so.
10 The signatories to the agreement included the Congolese government and its allies, Zimbabwe, Angola and Namibia; the RCD and its patron, Rwanda; and the Movement for the Liberation of Congo (Mouvement pour la Libération du Congo, MLC) and its patron, Uganda.
11 Ninth report of the Secretary-General on the UN Organization Mission in DR Congo, S/2001/970, Paragraph 30.
12 Human Rights Watch interviews, Bukavu and Uvira, October/ November 2001; this movement of RPA troops continued as recently as January 2002, according to a witness in Bukavu, Human Rights Watch telephone interview, January 8, 2002.
13 See, for example, "Casualties of War: Civilians, Rule of Law, and Democratic Freedoms," A Human Rights Watch Report, vol. 11, no. 1(A), February 1999; "Eastern Congo Ravaged: Killing Civilians and Silencing Protest," A Human Rights Watch Report, vol.12, no 3 (A), May 2000; "Uganda in Eastern DRC: Fueling political and ethnic strife," A Human Rights Watch Report, vol. 13, No. 2(A), March 2001; and "Reluctant Recruits: Children and Adults Forcibly Recruited for Military Service in North Kivu," A Human Rights Watch Report, vol. 13, No. 3(A), May 2001 (all also available in French and available on the Human Rights Watch web site: http://www.hrw.org).
14 See "The Inter-Congolese Dialogue: Political Negotiation or Game of Bluff?" International Crisis Group, November 16, 2001, located at http://www.crisisweb.org/projects/showreport.cfm?reportid=488, and "Storm Clouds over Sun City: The Urgent Need to Recast the Congolese Peace Process", International Crisis Group, May 14, 2002, located at http://www.crisisweb.org/projects/showreport.cfm?reportid=652 (accessed May 23,2002).
15 See U.N. Security Council, "Interim Report of the UN Expert Panel Report on the Illegal Exploitation of Natural Resources and Other Forms of Wealth of DR Congo," S/2000/49, 20th December 2000; See also "Scramble for the Congo: Anatomy of an Ugly War," International Crisis Group Africa Report No. 26, 20th December 2000 (http://www.crisisweb.org/projects/showreport.cfm?reportid=130, accessed May 22, 2002).
16 It has been estimated that as many as 15,000 "Rwandan Hutu armed forces" are in Congo, with approximately half fighting alongside government troops and half "operating as militias in the Kivus in eastern Congo (in Masisi, Shabunda, Kahuzi-Biega, and Virunga areas)." International Crisis Group, "Disarmament in the Congo: Investing in Conflict Prevention," Africa Briefing, June 12, 2001, p. 2.
17 On these forces, in particular ALIR, see "Rwanda: Observing the Rules of War?" A Human Rights Watch Report, vol.13, No.8 (A), December 2001.
18 Human Rights Watch interview, Bujumbura, July 2001. See also the report by the International Crisis Group, "Disarmament in the Congo: Investing in Conflict Prevention," the Congo government continues to provide material support for these groups, p.4-5.
19 Mai-Mai (also May-May or Mayi-Mayi) are sometimes known as the Popular Armed Forces (Forces Armées Populaire, or FAP). The name comes from the Kiswahili word "mayi" for water. Many Mai-Mai groups believe that they can be protected through rituals and charms which are said to transform bullets into water.
20 Human Rights Watch interview, October 20, 2001.
21 Human Rights Watch interview, October 19, 2001.
22 Human Rights Watch interview, Bukavu, October 20, 2001.
23 Human Rights Watch interview, Bukavu, October 20, 2001. See U.N. Security Council, "Interim Report of the UN Expert Panel Report on the Illegal Exploitation of Natural Resources and Other Forms of Wealth of DR Congo," S/2000/49, 20th December 2000; see also "Scramble for the Congo: Anatomy of an Ugly War," International Crisis Group Africa Report No 26, 20th December 2000 (http://www.crisisweb.org/projects/showreport.cfm?reportid=130, accessed May 22, 2002).
24 Human Rights Watch interview, Bukavu, October 20, 2001.
25 Human Rights Watch interview, Bukavu, October 20, 2001.
26 Human Rights Watch interview, Shabunda, October 22, 2001.
27 Human Rights Watch interviews in Uvira, July 2001.
28 International Rescue Committee, Mortality in Eastern Democratic Republic of Congo, Results from Eleven Mortality Surveys, 2001. The full report can be found on the IRC web site: www.theIRC.org/mortality.cfm, accessed May 22, 2002). The situation is so bad that IRC found that in some districts an estimated 75 percent of children have died or will die before their second birthday-children who have known nothing but war in their short lives.
29 Congo is currently ranked 152nd on the UNDP Human Development Index of 174 countries. UN OCHA Great Lakes regional Office, "Affected Populations in the Great Lakes Region (as of 3 September 2001)," Nairobi, p. 12, posted on ReliefWeb.
30 ASRAMES, Enquête socio-économique Nord-Kivu, Décembre 2000, quoted in Report of the WHO/UNICEF Joint Mission, Democratic Republic of Congo, 18-19 June 2001, Kinshasa, June 28, 2001.
31 U.N. OCHA, "Chronicles of a Humanitarian Crisis, year 2000, Democratic Republic of Congo," quoted in Save the Children, Oxfam and Christian Aid, "No End In Sight, The human tragedy of the conflict in the Democratic Republic of Congo," August 2001, p.10.
32 U.N. OCHA Great Lakes regional Office, "Affected Populations in the Great Lakes Region (as of 3 September 2001)," Nairobi, p. 11, posted on ReliefWeb (www.reliefweb.int). See map of affected populations in Congo by province, refugees and internally displaced, prepared by OCHA Great Lakes Regional Office, Nairobi, September 2001 on the same site.
33 Human Rights Watch interview, Uvira, October 30, 2001.
34 Report of the WHO/UNICEF Joint Mission, Democratic Republic of Congo, 18-19 June 2001, Kinshasa, June 28, 2001; citing B. Criel Van der Stuft and W. VanLerberghe, "The Bwamanda Hospital Insurance Scheme: A study of its impact on hospital utilization patterns," Social Science & Medicine 48 (1999), pp. 897-911; B. Criel & W. Van Dormael, "Voluntary Health Insurance in Bwamanda, Democratic Republic of Congo, An exploration of its meanings to the community," Tropical Medicine and International Health 3,8 (1998), pp. 640-653; and World Health Organisation, "Evaluation des systemes de surveillance epidemiologique en RDC: Kinshasa, Province du Bas-Congo, du Kasai Occidental et du Katanga," April 2000. The WHO/UNICEF Joint Mission Report also states: "Right now in Congo, the vast majority of health and education services is a business in which struggling workers have to play off their family's survival against that of their patients and pupils...Rational treatment and prescribing are abandoned when giving fewer or more appropriate drugs can be detrimental to income."
35 World Health Organization, "Democratic Republic of Congo Health Update," July 2001, p. 3.
36 Human Rights Watch interview, Bukavu, October 20, 2001. For this reason, particular care is taken in this report not to identify doctors and nurses or the establishment they work in.
37 Human Rights Watch interviews, October, 2001; and copy correspondence handed to Human Rights Watch detailing examples of these types of incidents, pillages, attacks on staff and patients.
38 Code zaïrois de la famille, art. 444. See chapter IX. on the legal framework.
39 In 1990 the net primary enrollment rate (percentage of age group) for boys was 61 percent and for girls 48 percent; in 1999 it was 33 percent for boys and 31 percent for girls (the 1999 percentages are the most recent data available within two years of 1999). The youth illiteracy rate (percentage of people aged 15-24) was 19 percent for boys and 42 percent for girls in 1990 compared with 12 percent for boys and 27 percent for girls in 1999. See Summary gender profile for the Democratic Republic of Congo located at http://genderstats.worldbank.org, accessed May 22, 2002).
40 Speech by Immaculée Birhaheka at a workshop on documentation of sexual violence held on October 22, 2001, Goma. Human Rights Watch also learned of such cases during its interviews.
41 Human Rights Watch group interview, Goma, October 23, 2001.
42 All names of victims and witnesses have been changed in order to protect their identity.
43 Human Rights Watch interview, Goma, October 25, 2001.
44 Human Rights Watch interviews, Bukavu October 17, 2001 and Goma, October 23, 2001.
45 Human Rights Watch interview, Bukavu, October 19, 2001.
46 Human Rights Watch interview with Gertrude Mudekereza, Program Assistant, World Food Programme, Bukavu, October 17, 2001.
47 Human Rights Watch interview, Goma, October 25, 2001.
48 Human Rights Watch telephone interview, Goma, October 26.
49 Human Rights Watch interview, Bukavu, October 19, 2001.
50 Human Rights Watch interview, Goma, October 25, 2001.
51 Human Rights Watch interview, Goma, October 25, 2001.