This year’s Nobel Peace Prize pair (Dr Denis Mukwege and Nadia Murad) provides the platform to intensify our efforts to address the consequences of conflict-related sexual violence (CRSV). There are inherently sensitive and complex issues surrounding sexual violence. Often victims face stigma from their community and family, causing what can be debilitating injuries and at times diminishing their quality of life through the physical and psychological consequences as a result of the sexual violence. This harm is only compounded by inadequate healthcare facilitates and insufficiently trained healthcare personnel, making victims more vulnerable. There are a diverse amount of efforts to address CRSV, from humanitarian and healthcare workers, to more broadly international organisations and to an extent the International Criminal Court in cases such as Ongwen. With Friday marking International Day of the Girl it is also worth highlighting the impact of CRSV on children, on whom such violence can have a devastating impact on their physical (trauma to genital, urinary retention and fistulas) and mental health with long term consequences.
While 2014 saw the efforts by states and celebrities to act to end sexual violence and promote the investigation and prosecution of such crimes, greater efforts need to be made to deliver assistance and reparations to such victims. Awarding the peace prize to Dr Mukwege is an important recognition of the work he has done for decades in providing assistance to victims of CRSV. Humanitarian organisations such as the ICRC and MSF have previously been awarded the peace prize. Yet this year’s acknowledgement highlights the work of an individual medic and a victim/advocate, putting human faces and personal narratives to conflict-related sexual violence. The specificity of this joint award to Nadia Murad, a victim of CRSV and Dr Denis Mukwege, an obstetrician and gynaecologist who is a human rights activist focusing on conflict-related sexual violence, confers a unique message: sexual and reproductive violence in all its forms demands an inclusion of vital actors in navigating solutions to CRSV. Through the healthcare lens, sexual violence may be visualised more comprehensively with enhanced understandings of physical and psycho-social consequences to the general public and legal community.
The timely recognition fittingly appreciates healthcare and humanitarian workers who are quietly enduring continuing security risks. The murder of 25-year-old ICRC midwives Saifura Hussaini Ahmed Khorsa and Hauwa Mohammed Liman in Nigeria serve as a reminder of how healthcare workers have increasingly become targets and special protections in International Humanitarian Law are being breached without regard. Furthermore, deliberately targeting obstetric and midwifery care, which provides women-centred care in conflict/post-conflict settings, could be interpreted as a form of gender and sexual-based harm that impacts communities and potentially intergenerational wellbeing and health. Yet, victims who are healthcare professionals receive less attention. The reasons are multi-faceted, but may be partially attributed to the perceived risks they tolerate to deliver life-altering medical care (bound by ethical duties), which has been echoed by the legal community’s record on pursing justice with no successful convictions for these crimes under international humanitarian law. These risks could be minimised by a stronger abhorrence by the international community and reflection on the value of medical care in terms of minimising the effect of conflict on health as well as their frontline expertise in identifying victims and appropriate remedies. The ICRC has been promoting the immunity from attack of healthcare and humanitarian workers through its #NotaTarget social media engagement.
Moving beyond assistance to reparations
There is also an important role for healthcare and humanitarian workers to contribute to shaping long-term solutions for victims of CRSV, such as reparations. Reparations are measures intended to acknowledge and alleviate the harm suffered by victims, but ultimately they are the responsibility of the state through a dedicated budget-line. There is an emerging practice at the international level for reparations for CRSV, including the Nairobi Declaration as well as state practice in Kosovo. After the collapse of the Bemba case where there was potential for innovating reparations to victims of CRSV, Court-ordered reparations are instead going to be provided as short term assistance.
For reparations for conflict-related sexual violence we have to look beyond just compensation, which can be useful, to trying to comprehensively remedy victims’ harm. This includes adequate and appropriate healthcare services for victims, both in the short term to mitigate injuries or complications becoming any worse, as well as in the medium and long term where victims’ needs and health can deteriorate over time. It also requires community socialisation to educate society on CRSV and not to stigmatise victims, as well as efforts to reintegrate the victims themselves so that they have opportunities to rebuild their lives and lead a dignified life. This is part of the work that Dr Mukwege has been doing through the City of Joy in Bukavu, DRC, but this requires more state engagement that such centres are not limited to single localities, instead part of a state funded nationwide programme. This can be difficult in countries during and emerging from conflict, needing the support and attention of the international community.
On receipt of this accolade, Dr Mukwege has highlighted the need for reparations for victims of sexual violence. He hopes, ’to draw a red line against the use of rape in armed conflict.’ Aligning these two aims is the reparation pillar of guaranteeing non-repetition of such violations. This Noble Peace Prize honours the dedication of medics and humanitarian workers such as Dr Mukwege, as well as the nature of their work which focuses on repairs beyond the legal and on a practical level. Therefore, to an extent the award represents an international acknowledgement of victims of conflict-related sexual violence and resultant harms. In a way this award can be seen as a form of symbolic reparation in acknowledging the wrongfulness of sexual violence, and to an extent the need for the international community to take more responsibility in its prevention and remedy.