Silence is the enemy

"I always think someone is following me and wants to rape me. It is better to die." --Darfuri refugee

Sometimes there comes a public health issue that's so big, so overwhelming, so heinous, that you just don't know where to begin discussing it. Nevertheless, the conversation should, and must, happen just the same. Silence may be easier, but speaking out is the only way to demystify the taboos and bring attention to what's going on for those who can't bring attention to it themselves. And maybe, just maybe, bring about some change.

It's no secret that rape happens during wartime. Certainly documents being discussed regarding our own soldiers' treatment of prisoners show that wartime rape--of either "the enemy" or even female colleagues--is not limited to rogue armies in far-off countries some Americans probably couldn't even find on a map. That doesn't make it any less inexcusable, or the crimes any less horrendous, just because we've done it, too.

A recent piece in the New York Times by Nick Kristof highlighted the extent of these rapes even after the war has stopped, discussing rape in Liberia. As Kristof notes, the war in Liberia ended officially in 2003 after 14 years. However, even today--6 years into peacetime--a high percentage of the female population reports a history of rape, including girls as young as 3 years old. Of 275 sexual violence cases treated in just four months' time in Liberia by Doctors without Borders, 28% involved children age 4 or younger, and a third involved children ages 5-12. Children are easy targets, and the most powerless of all possible victims.

Of course, rape is older than civilization itself, just like the view that women are second-class citizens (if we count as citizens at all). You may have heard about these types of rapes--of women, of children, by solo men or gangs; using only their bodies or using whatever object is handy, including guns or knives, to rape their victims--being carried out in Darfur, in the Congo, or elsewhere. Celebrities have written about it in excruciating detail, documenting some of the horrors: a child held and raped for 2 weeks, left alive but incontinent, humiliated, and shamed. 6-month-old infants raped. 80-year-old women raped and brutalized. 1,100 women raped every month in Eastern Congo according to United Nation estimates.

The situation in Darfur probably has received more international attention than other countries, yet still, little has been done--and the future of what *can* be done is uncertain, as many foreign aid groups were kicked out in March.

For those who have fled the brutality in Darfur, the situation remains bleak. A new report was just released documenting the issues Darfuri women face in refugee camps, including repeated rapes and a lack of any legal recourse either in their home country or in the camps. They are imprisoned--unable to help themselves by even getting firewood or tending to animals because of the potential for rape at the periphery of the camps--and have no one to turn to. Indeed, in many areas, the perpetrators carrying out these crimes are the very ones who are supposed to be protecting women--police, military and government officials, even teachers. In Liberia, despite having the first female president of an African country, little progress has been made in changing laws or attitudes about rape, and the country still lacks an adequate legal system able to adequately prosecute the small percentage of rapes that are reported.

What to do about this? That's what's kept me from writing more about this, I suppose--the sheer magnitude of what is happening, and the helplessness one feels when reading about it. With infectious diseases, though some of them are equally overwhelming, at least there is the hope of prevention via relatively simple devices (bed nets for malaria; condoms for HIV; isolation and medical treatment of TB, and of course the hope for vaccines, etc.) With systematic rape, there is no drug or vaccination to look for in the future. What is needed instead are shifts in attitude: more respect toward women; societal intolerance of such crimes by men; empowerment of women and girls; an understanding by family members of those who were raped; cessation of femicide. These are overwhelmingly difficult things to ask for, especially in countries fragmented by years of war and violence. How does one help to accomplish these things in far-off countries, when it's hard enough to be respected as a woman right here in the U.S.?

A recent editorial by the editors of PLoS Medicine provides some places to start:

Medical professionals are powerful lobbyists whose recognition of the devastation could galvanize support for the work of humanitarian organizations and advocacy groups in documenting sexual atrocities and holding states accountable when human rights and international law are violated. Together with medical journalists and editors they have done much to try to expose the devastation of sexual violence during conflict, but we can all do more to document and disseminate the research and accounts of health workers, nongovernmental organizations, and survivors.

And they're right. No, gang rape isn't exactly great fodder for cocktail parties. It's incredibly uncomfortable and depressing to speak about--and that's probably one reason it's gone on as long as it has, with relatively little attention. It's taboo to discuss--not only in countries like Liberia or Sudan, but here in the US as well. It needs to stop, and we can help make that happen. Talk to someone about this. If you can't do it in person, write a letter. Write your congressperson. Hell, write your mayor. Highlight it on your own blog. See if a local women's group--or any other group interested in global health or women's rights--has covered the issue recently, and if not, offer them any of the linked articles to spark the conversation. Email your local newspapers or TV stations. Send a mass email to your friends--this is certainly more important and worthy of their attention than the latest viral YouTube video, right?

Finally, keep checking back. This month frees up a bit of time for me, so I'll highlight some of the other posts on this topic around the blogosphere as I see them crop up, in order to keep the discussion going and look for other ways to help and other perspectives on the issues. I'll also write on some related topics. Additionally, keep an eye on Sheril and Isis's blogs for more posts and updates. Along with them (and potentially others, which I'll mention as I see them), I'll be donating any wages from the blog this month to Doctors Without Borders as a token of appreciation for the work they've done for the victims of these brutal crimes. I'll have a list of other charities you may want to consider in a future post.

Silence is the enemy. Speak out. Pass it on.

[Edited to add: Sheril has a list of participating blogs here, including NY Times author Nick Kristof with his post highlighting the movement. We now have a Facebook page for "Silence is the Enemy" here; and you can search Twitter using #silencehurts.]

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Thank you for writing about this. I recently wrote about the mass rapes in the Congo, and it is just not a subject that is getting enough media attention. You are absolutely correct when you say "silence is the enemy".

Thank you for this post. I will be making a post about this myself and I'll spread the word where I can.

This is so terrible and we can't close our eyes and ears just because it's uncomfortable.

Women's groups are aware of it, have a friend who did a semester abroad in community health in South Africa. Rape, even gang and child rape, is off the charts(unless you are white living in an enclave), and yet it's considered a "developed" nation.

What all these countries need are strong,honest governments , some nations may not be ready for western-style freedoms and democracy. They need to be ruled with a heavy hand that's going to meter out justice swiftly and fairly, to let the populace know they take the whole rule of law thing seriously, and that laws take precedence over local customs and traditions.

In many places, it's known that rape and sexual abuse is wrong, but as nobody is enforcing the standard, or enforcing it laxly, people do what they can get away with.

You've brought up some important points, however, it is important to note that male rape is also extremely prevalent in the U.S. as well as around the globe, and the rate of males reporting rape are even less than that of females because of stigma, shame and other cultural issues.

What must become apparent...what is CRITICAL to that violence is a Public Health issue that affects men, women, old, young, and mentally/physically disabled individuals. Rape is about power, and the ability to demonstrate anger, aggression and power over others. When we make rape solely a woman's issue, we in essence cheapen it by making it uniquely a woman's problem, and we ignore all of the other individuals who suffer from sexual violence. We ignore children (boys and girls), we turn blind eyes to the elderly who are abused, and we cannot fathom that those who are disabled suffer at the hands of perpetrators.

I encourage everyone who is concerned about issues of rape and sexual violence towards women to think with a broader mind and understand...realize...that this act of violence is ageless, genderless and knows no bounds. When we begin to do that, then we (as a public health community) might be able to mitigate the circumstances under which this terrible crime occurs.

It is revolting, but as you said, needs to be brought to light and awareness amplified. I think sewing the seeds which empower women is the best long term hope. Although not about rape, I just finished reading "Three Cups of Tea," about the brave start of schools (that include girls) in remote Pakistan and Afghanistan. I'm mulling over a stint with Doctors without Borders one day, but must admit I'm not currently that courageous:…

I absolutely agree that silence is the enemy. At my high school, four girls were gang raped and everyone knew about it but no one said anything to administration until one of the girls tried to hang herself in the bathroom. It needs to be talked about more than not. Thanks for bringing attention to it. Speak up!
Kitchen Scales


Atheists caused 9/11? Come on. Don't be silly. Saying things like that make you as senseless as the people that hijacked the planes and crashed them into the buildings. More people are dying in the name of "God" than ever. Let's be realistic.


By James Beasley (not verified) on 19 Sep 2009 #permalink

If you're a high school student, how many times have your friends and family asked you that question? Or, it's counter-part, 'what do you want to do when you grow up?' It may get annoying to you, but really, all they want to know is what your interests are, what you are thinking about studying, and if you know what type of work you might like to do in the future. As early as your freshman year in high school, there are several things that you should consider to help you get pointed in the right direction. Here are a handful of them:

College Prep Curriculum

Your high school guidance counselor can recommend courses that provide a good preparation for college. They may not know everything related to every career or even what the financial aid options are that you have, but they can help here. Each college specifies how many English, math, social studies, foreign language, and science classes applicants should take to qualify for entrance, but there are similarities among colleges. So, make sure you are taking the right courses and enough of them.

Advanced Placement Courses and Exams (AP)

AP classes give you a chance to complete college work while still in high school and are offered in many subjects. They enable you to study an area in greater depth and challenge yourself to do college-level work. They can be rewarding because you gain new skills and study habits. If you pass the AP exam at the end of term, you can receive college credit. If you do well, your chance of getting into the college of your choice improves because you have demonstrated that you can succeed in college-level courses. The AP courses you complete in high school can often be skipped in college, saving you time and your parents money. Just be careful not to overload yourself with too many of these...we donât want to see your grades suffer!

College Visits

As early as your freshman year, but definitely by your junior year at the latest, plan to visit several colleges you think you might like to attend. If you're unsure about where you want to go, then pick a range of schools that are close by. Be sure to visit some state schools, as well as some private schools as well. And always be sure to go while school is in session. That part is critical, so you can see what the students look like, not just the buildings. This will also allow you to see if the students look like the kind of people you want to be hanging around with for four years of your life.

And, when it comes time to apply, Iâve found that you are best suited if you apply to 8 universities, give or take a couple. The transition from high school to college is one of the defining moments in your life, and you want to have the best shot of success possible. So, be sure to use your time and energy in high school wisely by getting good grades, challenging yourself, and using the time to explore your interests.

What do you think of the prevalence of the use of the "F"-word or gestures?

Well-meaning people, liberals, pacifists, women and men, young or young at heart, modern Americans, use the F-you when they are mad. I can't but think that taken literally, the word means, "I am mad at you and I will gladly rape you because you made me mad."

What does it say about our society, when we use the same word to mean a biological act or a fun activity -- and the same word to express anger? Aren't the bad people in Africa just doing what many American say they would do?

Is modern use of language here so casual that no one thinks what it really means?

By stilldreaming (not verified) on 14 Oct 2009 #permalink

Thank you for the suggestion of donating to MSF. Writing letters is good but I always like to put my money where my pen is.