DAY FIVE: No justice without healing; no healing without justice: Pathways to care for sexual and gender-based violence in Somalia and DRC 

The authors from the Displacements Project draw attention to the different pathways of care that sexual violence victim-survivors take to address their needs. Focus groups were conducted across four sites in DRC and Somalia.

The Displacements Project 

Featured image credits: SIDRA from the Displacements Project website

Decades of conflict in the Democratic Republic of Congo (DRC) and Somalia have displaced millions within and across borders. This has been exacerbated by natural disasters such as floods, tsunamis, droughts, famine, and even locust infestations. Internally displaced persons (IDPs) have settled in urban and rural areas, in segregated camps, or have been integrated in ‘host’ populations. These conflicts have severely eroded the state’s capacity to provide healthcare as well as administer justice and rule of law, making sexual and gender-based violence (SGBV) difficult to address holistically. In the state’s absence, people turn to alternative ‘social connections’ including international and local NGOs, indigenous healers, and community elders.  

Interested in mapping out these social connections, we conducted focus groups separated by gender across four sites in South Kivu, DRC, and five sites near Kismayo and Garowe, Somalia. We asked the participants where people go if they experience deep sadness, persistent physical pain, or SGBV.i  

Participants noted that SGBV was perpetrated at the household/domestic level by spouses or close family members; at the community level by somebody outwith the household yet known in the community; and in DRC, by armed combatants, which leads to severe physical harm, often requiring hospitalisation.  In response, victims turn to different pathways to address their needs. Proximal pathways can include friends, families, or neighbours, who may witness violence, offer material and/or emotional support, although they may also be the perpetrators of violence. This discussion among women about domestic rape in Katogota, DRC demonstrates the complexity of proximal pathways: 

Woman 1: ‘You go to a friend because talking with someone frees you up and makes you feel better.  

Woman 2: ‘I think we should tell the mother who is the president of the church because at least she can’t tell everyone in the village your secret because she is wise and God-fearing.’  

Woman 3: ‘I think it’s best to turn to your parents because they will always be there with you despite your decision.’  

Woman 4:‘A neighbour—’ 

[People in the group yell and interrupt and say telling a neighbour is a bad idea because they will tell everybody your secret.] 

Healthcare pathways include a spectrum from care for life-threatening injury to treatment for things such as STIs. Both DRC and Somalia have access to care for extreme violence. However, due to stigmatisation and costs, there is less uptake for ongoing health support. Through local organisations such as the Mukwege Foundation, DRC has more access to professional psychosocial support, although this is difficult to access in rural peripheries. In both countries, victims access informal emotional support through proximal pathways as well as religious or informal financial groups.  

Justice pathways are the means to seek amends or redress for SGBV harms. In the DRC, international actors are heavily involved in the justice system, yet impunity for armed combatant perpetrators is often the norm.

A woman in Kavumu, DRC made this clear by saying, ‘I would advise them to go to the state, but we know that the state will not give any help.’ In the absence of the state, when domestic or community level sexual violence occurs, informal, customary, or clan-based justice is applied.

In DRC this often means that sexual assault is addressed by family or ethnic leaders resulting in mediated marriages, which are unwelcome to the women victims. In Somalia, clan elders agree on material compensation, known as xeer in Somali, whereby wealth is transferred to families/clans, but not the victims. Participants in both countries said this gendered justice system did not lead to a sense of justice, which exacerbates mental health harm from SGBV. A woman in Kismayo made clear their exasperation with justice when reflecting on a rape case involving a young girl, which went through clan elders:  

When a case like this happens, the traditional leaders take over the case, and the case is not taken up by the rule of law agencies. This needs to change. The perpetrators must get harsh punishment so that it will be a lesson for those who are inclined to do similar horrible crimes. 

Despite the erosion of the state in DRC and Somalia, there are still state and local organisations and institutions providing health, mental health, and justice services. In Somalia, this is ad hoc, and not systematically integrated. In South Kivu, the Panzi Foundation, founded by Nobel Peace Prize winner Dr. Denis Mukwege, administers Panzi Hospital, which incorporates locally-based wraparound economic, medical, psychosocial, and justice support and advocacy, offering a model for post-conflict situations. This ‘one-stop’ model provides free trauma sensitive medical and psychosocial care to victims and families; advocates to state actors and local community leaders; gives legal aid; and provides livelihood training and start-up funding. We contend that supporting healing for SGBV victims requires similarly holistic syncing of pathways of health, mental health, and justice, which must involve the state, international, and indigenous institutions and actors. This necessitates a comprehensive understanding of local milieus, including the cultural logics behind where people actually turn to for care. It is not enough simply to address the barriers to formal systems.   


Authors’ bio 

This blog comes from the recently published article, ‘Pathways to care: IDPs seeking health support and justice for sexual and gender-based violence through social connections’. The co-authors—Clayton Boeyink, Mohamed A Ali-Salad, Esther Wanyema Baruti, Ahmed S. Bile, Jean-Benoît Falisse, Leonard Muzee Kazamwali, Said A. Mohamoud, Henry Ngongo Muganza, Denise Mapendo Mukwege, Amina Jama Mahmud—are based at the Somali Institute for Development and Research Analysis in Somalia, the Université Evangélique en Afrique/Centre d’Excellence Denis Mukwege in DRC, and the University of Edinburgh and are collaborating on a ESRC/Global Challenges Research Fund (GCRF) project aiming to help Somali and Congolese displaced people to access healthcare associated with protracted displacement, conflict, and sexual and gender-based violence ( 

A special thanks to research assistants supporting data collection in DRC: Arcene Kisanga, Naomie Amina Mirindi, and Blandine Mushagalusa Ndamuso; and in Somalia: Mohamud Adan Ahmed, Omar Yusuf Ahmed, Mohammed Fahim Bishar, Muna Mohamed Hersi, Anisa Said Kulmiye, Ahmed Mohamed Mohamoud, and Amina Mohamed Nor. 

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