Medical-Legal Collaboration Leads to Justice in Serial Rape Case in Democratic Republic of the Congo

This week, The Lancet, the prestigious peer-reviewed medical journal, published a Viewpoint describing how a collaboration among Physicians for Human Rights (PHR), Panzi General Reference Hospital in the Democratic Republic of the Congo (DRC), and other medical-legal partners helped bring long-delayed justice to dozens of young Congolese girls who were raped by a local armed militia. The partners trained clinicians to collect and document critical forensic evidence "to corroborate witness testimony and to provide key physical and psychological data about the survivors without compelling them to testify in court," according to the piece, which was co-authored by representatives from PHR, Panzi Hospital, and King's College Hospital NHS Foundation Trust in the UK.

The collaboration made a crucial contribution to the groundbreaking case, in which 11 men, including a local lawmaker, who had been found guilty in December 2017 of crimes against humanity for the rape of dozens of young girls between the ages of 18 months and 11 years in the Congolese town of Kavumu. Between March 2013 and December 2015, the girls were abducted from their homes in the middle of the night, taken to nearby fields, raped, and abandoned. The convicted men were also found guilty of the murder of two men. A 2018 appeal judgment upheld the landmark conviction.

The 2017 decision was the first successful conviction of sexual violence as a crime against humanity in the DRC for a sitting lawmaker, and the first conviction in the DRC for sexual violence as a crime against humanity for serial assaults that took place over several years, setting critical precedents.

The Lancet Viewpoint, "The case of Kavumu: a model of medicolegal collaboration," was co-authored by Karen Naimer, PHR's director of the Program on Sexual Violence in Conflict Zones; Dr. Muriel Volpellier, who serves as an expert consultant to the program and is lead forensic physician at the Haven Paddington in London, a sexual assault referral center managed by King's College Hospital NHS Foundation Trust; and Dr. Denis Mukwege, a world-renowned gynecological surgeon who is the founder and medical director of Panzi Hospital in Bukavu, DRC and co-recipient of the 2018 Nobel Peace Prize for his efforts to end the use of sexual violence as a weapon of war. The Viewpoint was published in volume 393.

In 2011, PHR established its Program on Sexual Violence in Conflict Zones, a training and advocacy initiative to enhance the capacity of medical personal, law enforcement, and legal professionals to collect, document, analyze, preserve, and share forensic evidence of sexual violence to support local prosecutions. PHR worked with clinicians from Panzi Hospital's sexual violence unit, a major medical facility where all the Kavumu survivors were treated, to design and implement a series of training programs to enhance forensic medical competencies. As they treated the child Kavumu survivors, the clinicians - trained by PHR - were able to capture forensic medical evidence of sexual violence, document the findings, and present them to the court trying the case.

"Countless sexual violence cases have failed in the DRC's legal system in the past against far less powerful defendants because of the absence of adequate forensic evidence," said Karen Naimer of PHR. "In this case especially, the role of clinicians and their ability to provide medical-legal evidence to the court was an essential component in securing justice for these young girls who have survived unspeakable violence."

PHR partnered with Panzi Hospital and TRIAL International, a Swiss-based non-governmental organization, to organize a forensic evaluation of 36 of the 42 known Kavumu survivors. In order to ensure that the children were not re-traumatized by having to repeat their testimonies in court, video interviews were conducted with each child survivor (who gave informed consent) about the assault. This method and other precautionary procedures employed throughout trial proceedings were among the first survivor-centered protections to be used in a Congolese court.

"Thanks to collaboration among Panzi clinicians and lawyers, law enforcement, activists from the Kavumu community, and other partners, a landmark judgment was reached that illustrates a promising way forward toward pursuing justice for some of the most vulnerable people around the world," Naimer added.

According to the trial judgment, the medical-legal evidence included in this case was valuable to corroborate witness testimony and provide key physical and phycological data about survivors, without forcing them to testify in court and risk re-traumatization. The successful production of this kind of pivotal evidence exemplifies the important role clinicians can have in addressing and prosecuting sexual violence.

"Clinicians have a responsibility to develop the skills necessary to capture important forensic evidence," said Dr. Denis Mukwege of Panzi Hospital. "Hospitals, governments, and educational institutions must support and provide the training and mentoring needed to develop forensic skill building. Additionally, the global health community must recognize the crucial role clinicians can play and should support this effort by investing technology and funding into training, dissemination of tools and standard practices, and supporting quality assurance and improvement processes to ensure sustainability."

The Lancet piece is accompanied by a video timeline illustrating key dates in the case, as well as the medical-legal collaboration among PHR and its partners.

Additional PHR Resources, including multimedia, on its work to end sexual violence in conflict zones:

• Video: Landmark Child Rape Trial in DRC's Kavumu, July 11, 2018
• Photos: Kavumu Child Rape Trial, November-December, 2017
• Press Release: Landmark Kavumu Appeal Verdict Upholds Convictions, July 26, 2018
• Blog: "A Victory for Justice in the Congo," December 19, 2017
• Where We Work: Democratic Republic of the Congo
• Focus Area: Sexual Violence
• Report: "Enhancing a Regional Response to Crimes of Sexual Violence," December 1, 2015
• Blog: "Dr. Alumeti and Panzi Hospital: Symbols of Health and Hope for Survivors of Sexual Violence in Congo," June 24, 2011