Don't let the suffering make you fade away: An ethnographic study of resilience among survivors of genocide-rape in southern Rwanda

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Abstract

Rape has been used in contemporary armed conflicts to inflict physical, psychological, cultural and social damage. In endeavoring to address the psychological damage of collective violence, some researchers and global health practitioners are turning toward post-conflict mental health promotion approaches that centrally feature resilience. Though previous findings from resilience and coping research are robust, few studies have actually investigated resilience among genocide-rape survivors in cultural context in non-Western settings. This paper presents ethnographic data gathered over 14 months (September 2005 to November 2006) in southern Rwanda on resilience among genocide-rape survivors who were members of two women's genocide survivor associations. Study methods included a content analysis of a stratified purposive sample of 44 semi-structured interviews, as well as participant-, and non-participant-observation. Resilience among genocide-rape survivors in this context was found to be shaped by the cultural-linguistic specific concepts of kwihangana (withstanding), kwongera kubaho (living again), and gukomeza ubuzima (continuing life/health), and comprised of multiple sociocultural processes that enabled ongoing social connection with like others in order to make meaning, establish normalcy, and endure suffering in daily life. The results of this research show that the process of resilience among genocide-rape survivors was the same regardless of whether genocide survivor association membership was organized around the identity of genocide-rape survivorship or the identity of widowhood. However, the genocide-rape survivors' association members were more involved with directing resilience specifically toward addressing problems associated with genocide-rape compared to the members of the genocide widows' association. The findings from this research suggest that ethnographic methods can be employed to support resilience-based post-conflict mental health promotion efforts through facilitating collective sexual violence survivors to safely socially connect around their shared experiences of rape, neutralizing social threats of stigma and marginalization.

Introduction

Rape is a violation of the social body as well as a violation of the self (Cahill, 2001). When perpetrated on a massive scale, rape provokes maximum terror by damaging and destroying multiple aspects of human life including social bonds, cultural practices, bodies, and psyches (Robben & Suarez-Orozco, 2000). According to the World Health Organization's (2002) typology of violence, rape employed in armed conflict, war or genocide can be understood as both collective and sexual violence (CSV). CSV has been used in contemporary genocide and warfare to create widespread fear and demoralization, to deliberately subvert community relationships, and to degrade and humiliate targeted groups of people (Gingerich and Leaning, 2004, Reid-Cunningham, 2008).

Current academic debates on the issue of war- and genocide-rape have questioned whether the international criminalization of rape signals true progress in the struggle to eradicate all forms of CSV or deeper entrenchment of problematic assumptions regarding women's agencies and identities (Barnes, 2005, Farwell, 2004). Scholars have argued that “sexual violence as a deliberate strategy in war and political repression by the state is connected in a range of ways to sexual violence in all other contexts,” (Kelly, 2000: 45), and that the roots of violence against women pattern social order during both peace time and war time (Olujic, 1998). Re-visitation of the 2000 “Landmark” Resolution 1325 on Women, Peace and Security, the United Nations Security Council (2005) noted that sexual gender-based violence is a persistent obstacle for achieving women's peace, well-being and security, especially in post-conflict settings.

Though women and girls comprise the overwhelming majority of CSV victims/survivors, women and girls also inhabit multiple and overlapping identities and roles during and after violent conflict. These social positions include warriors, soldiers, mothers and wives socializing men for war and/or against war, political leaders, feminists, heroes, war reporters, spies, and the dead (Elshtain and Tobias, 1988, Enloe, 2000, Lorentzen and Turpin, 1998, Saywell, 1986). For example, women were both “agents and objects” in the 1994 Rwandan genocide (Sharlach, 1999: 387), during which rape, gang rape, sexual torture, sexual slavery, and forced “marriage” were used systematically against an estimated 200,000 to 350,000 women and girls (Rights, 2004, Amnesty International, 2004, Bijleveld et al., 2009). Though grassroots networks of women coalesced to provide care for the twenty- to fifty-thousand women and girls who survived genocide-rape (Cohen et al., 2005, Turshen, 2002), observers have noted the threat of severe stigmatization and marginalization if their status was or became known by their families or the public community (Amnesty International, 2004, Mukamana and Brysiewicz, 2008). Moreover, women and girls who were already known in their communities to have survived rape have been suspected of harboring sexually transmitted infections (especially human immunodeficiency virus (HIV)), accused of having collaborated with genocide perpetrators in order to survive, deemed unable to marry, abandoned by their husbands, or affected by ostracizing medical problems such as obstetric fistula (Amnesty International, 2004).

Under the guidance of the WHO directive to address the psychological damage of war and conflict, the global health community is in the midst of learning how best to respond to various forms of collective violence (WHO, 2002). The extent of short- and long-term negative health consequences from CSV is extremely difficult to estimate. Furthermore, the challenges of meeting the myriad health needs of survivors of CSV are complicated by the absence of adequate health care in many conflict-affected settings (Ward and Marsh, 2006, Zraly et al., in press). Health-related consequences of CSV are unwanted pregnancy, gynecological complications and injuries, sexually transmitted infections (including HIV/acquired immunodeficiency syndrome (AIDS)), post-traumatic stress disorder (PTSD), common mental disorders, and suicidal thoughts and behaviors (WHO, 2002). Reports have documented disproportionally high rates of HIV/AIDS among genocide-rape survivors in Rwanda (Rights, 2004, Nduwimana, 2004), as well as persistent psychiatric suffering (Amnesty International, 2004).

Survivors of rape in war and genocide often experience trauma and other forms of mental health distress (Gingerich and Leaning, 2004, Mercy et al., 2003, Ward and Marsh, 2006). However, war-related trauma is a complex and controversial concept and there is “no agreement on the appropriate type of mental health care” (Kienzler, 2008: 218) that should be provided following collective violence. While some researchers have suggested that the trauma of political violence be approached as a normal psychosocial response (Bracken et al., 1997, Pedersen, 2002, Summerfield, 1999), others have endeavored to “determine and verify the effects of violent conflicts on the mental health of those affected by focusing on war trauma, PTSD, and other trauma-related disorder,” (Kienzler, 2008: 218). To move beyond this impasse, Miller and Rasmussen (2010) have suggested bridging the conceptual frameworks of psychosocially oriented and clinically focused approaches to post-conflict mental health.

Section snippets

The resilience way

Increasingly, researchers and practitioners are exploring the applicability of salutogenic (health-centered) post-conflict mental health promotion approaches (Almedom, 2004, Betancourt and Khan, 2008, Ghosh et al., 2004). Mental health promotion is a public health strategy that seeks to protect and strengthen existing mental health, to prevent future threats to mental health at the group (e.g. community or population) level, and to specifically and historically addresses issues of power and

Methods – phase one

As previously described (Zraly et al., in press), the first author conducted fieldwork from September 2005 to November 2006 in the university town of Butare, Rwanda as well as the four contiguous Huye, Mukura, Ngoma, and Tumba Sectors of Huye District, Southern Province, Rwanda. The first eight months of ethnographic fieldwork was largely comprised of developing relationships with genocide-rape survivors who were members of two distinct survivors' associations. The first was Abasa, a

Characteristics of the stratified sample

Abasa members often identified themselves by the categories of girlhood and womanhood that they occupied at the time of genocide-rape experience, emphasizing that the rape of unmarried girls disrupted the normative cultural pattern of gender identity by forcing girls them into a painful social space where they were neither girls nor women. Within the Abasa association, abagore (women) had been married and/or had at least one child during the time of the genocide, while abakobwa (girls) had not

Discussion

Rwandan genocide-rape survivors suffered in extremis during the genocide, and each of their genocide-rape experiences is unique. Yet, among genocide-rape survivors located in women's associations in southern Rwanda, the process of resilience appeared to be patterned by the culturally specific concepts of kwihangana, kwongera kubaho, and gukomeza ubuzima. Kwihangana was found to be an intrapsychic creative process of drawing strength from within the self in order to withstand suffering. Kwongera

Conclusions

In field of global mental health, resilience-centered mental health programs hold promising potential for application in the humanitarian, health, and development sectors as responses to the needs of CSV survivors. Parallel to discussions of the trauma/PTSD debates in psychiatric anthropology, a resilience debate is coming to the fore. While some resilience researchers attempt to establish resilience as a universal and cross-culturally valid psychological response to traumatic distress based on

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    The research on which this paper was based was supported by a Fulbright Grant from the International Institute of Education, and a Baker-Nord Center for the Humanities Graduate Research Assistance Grant through Case Western Reserve University. In addition, this material is based upon work supported by the National Science Foundation under Grant No. 0514519. A generous 2009 Ethel-Jane Westfeldt Bunting Summer Scholarship at the School for Advanced Research on the Human Experience provided the time and space for revising this manuscript. The National University of Rwanda (NUR) School of Public Health provided institutional support for this research, the Center for Conflict Management at NUR provided safe spaces to carry out this research, and the NUR Research House, provided a supportive environment for this work. UWAMUGUHA Clémentine, NDAMUZEYE Chrysostome, NTWARI Justice, UWINEZA Josiane, NKUSI Inga Jessica, UWAMAHORO Chantal, GASANA Marcellin, GATETE Thierry Kevin, and NIRAGIRE Hervé all provided invaluable research project assistance. We are deeply grateful to the leaders and members of AVEGA-Agahozo and Abasa who shared their experiences and granted their permission to conduct this research. And we are very thankful to the District and Sector leaders in the Southern Province of Rwanda who supported this research. Lastly, the authors wish to thank the anonymous reviewers who read and commented on earlier drafts of this paper, which was significantly advanced by their insightful suggestions.

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