The destructive impact of sexual violence on individuals as well as on society as a whole is overwhelming. In the last few years, local organizations have drawn attention to the extent of the crisis in eastern Congo and have been the first to offer help to victims. Congolese civil society is vibrant and has long been a major support to affected populations in eastern Congo. With the war and the erosion of official services, these groups have often offered the only help available to those in need, including to those who had suffered crimes of sexual violence.
Women and girls who have suffered crimes of sexual violence must have their medical and psychological needs met both to relieve their immediate distress and to give them strength to pursue judicial redress. A person who is in pain, is incontinent, or depressed is unlikely to take a case to court.
Women and girls who have been victims of sexual violence suffer from fistulas and other injuries as well as from infections and sexually transmitted diseases, including HIV/AIDS. Some get pregnant and suffer from rape-related complications during the pregnancy or birth. Abortion is illegal in Congo.164 Some victims have attempted to get abortions and suffered complications from these unsafe procedures.
The prevalence of HIV/AIDS in Congo is unknown, but it is likely that many women and girls raped by soldiers and combatants have contracted HIV/AIDS. The prevalence of the infection among combatants is generally above the average infection rate of the Congolese population, and violent assault increases the risk of infection through tears and injuries to genital tissue. UNAIDS estimates that the nationwide prevalence rate is at about 4.2 percent, but the National Program to Combat AIDS (Programme nationale de lutte contre le SIDA) estimates the prevalence in eastern Congo to be much higher, between 20 and 22 percent.165
Most victims of sexual violence have no medical examination or treatment after their assault. They live in rural areas where medical services are not available, they lack money for treatment and even to pay for transport to a clinic, or they fear that a medical visit will make the rape publicly known. Already before the war, the Congolese health system was in a dilapidated state and during the war, many health centers and hospitals were looted and destroyed. In places where buildings are still standing, staff to deliver services or needed drugs and equipment are in short supply or even lacking altogether. Centers to test and treat HIV/AIDS are especially needed and there are few of them, mostly located in urban centers. Only one program in eastern Congo, based in Bukavu, provides anti-retrovirals to HIV/AIDS infected persons and it treated only 127 patients by October 2004.166 Post-exposure prophylaxis drugs a course of drugs that can prevent HIV infection if taken within 72 hours after the rape and drugs preventing mother-to-child transmission of HIV are also not widely available. Church-related health agencies offer some limited medical aid in rural areas and some local NGOs such as Solidarity for Social Support and Peace (SOPROP), PAIF and Centre Mater Misericordiae provide primary care in Goma, Kitshanga, Butembo, Katana, and Bukavu.
Given the widespread reports of sexual violence and the devastating consequences of becoming infected with HIV/AIDS as a result of sexual violence, medical clinics should screen for sexual violence, routinely provide information to all patients regarding transmission, voluntary testing and counseling, and treatment for HIV/AIDS.
Beyond the physical consequences of the crimes, women, girls and their communities have to deal with the psychological and social effect. Many victims of sexual violence are depressed, suffer from psychosomatic illnesses or even commit suicide. If the rape resulted in pregnancy, most women and girls have given birth to the babies, in part because abortion is not just illegal but seen by many as immoral. Mothers of these children struggle to find ways of living with these children born out of rape, and they and their children are often rejected by their families. Consequences of such rejection are serious since families in the Congo are often the only safety net for assuring protection and survival to the vulnerable.
By mid-2004 there was a wide range of organizations in eastern Congo providing psychological counseling, practical assistance such as vocational training or micro-credit programs, and general support in overcoming the stigma and isolation connected to having been a victim of sexual violence. But widespread rape has torn apart individual lives as well as communities and the help offered thus far falls short of meeting the need.
Several local NGOs have sought to offer legal help to victims seeking justice. A relatively recent development, the provision of these services may well grow as increasing numbers of victims seek legal redress. In South Kivu, AED and Congolese Initiative for Justice and Peace (Initiative Congolaise pour la Justice et la Paix, ICJP) provide legal advice and assistance to women and girls who are victims of sexual violence while in North Kivu, SAJ in Goma, and CEJA in Butembo provide legal assistance to these victims.
Since the transitional government entered office, it has taken only very limited steps to dealing with the problem of sexual violence. It delegated representatives to participate in a U.N.-led mission to assess the problem of sexual violence in eastern Congo and it announced that the national Social Fund would pay for urgent medical assistance to victims of sexual violence.167 Efforts being undertaken to make the military and civilian justice systems operate efficiently will, of course, facilitate prosecution of perpetrators of crimes of sexual violence.
 In Congo, abortion is outlawed except when a doctor considers that the pregnancy could be fatal for the mother. Human Rights Watch believes that decisions about abortion belong to a pregnant woman without interference by the state or others. The denial of a pregnant woman's right to make this decision violates or poses a threat to a wide range of human rights. Governments should take all necessary steps, both immediate and incremental, to ensure that women have informed and free access to safe and legal abortion services as an element of womens exercise of their reproductive and other human rights. Government responsibilities relating to womens access to abortion that are founded on economic, social, and cultural rights must be implemented according to the principle of progressive realization to the maximum of available resources. Abortion services should be in conformity with international human rights standards, including those on the adequacy of health services.
 Programme national de lutte contre le SIDA, Plan stratégique de lutte contre le VIH/SIDA/MST (1999-2008). September 2003; UNAIDS/WHO, Epidemiological fact sheets on HIV/AIDS and sexually transmitted diseases Democratic Republic of Congo (www.unaids.org/EN/Geographical+Area/by+country/democratic+republic+of+congo.asp, accessed on January 17, 2005).
 Médecins Sans Frontières, Kinshasa and war-torn Bukavu region, DRC, celebrate first year of ARV treatment, (http://www.msf.org/countries/page.cfm?articleid=6142E492-A180-4608-87CCBF0F0A0B812B, accessed on January 17, 2005).
 Speech of President Joseph Kabila, March 8, 2004, accessed on May 6, 2004 on http://www.digitalcongo.net/fullstory.php?id=34987.