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Listening to Displaced Rape Survivors Project

Executive Summary

Throughout what is now well over a decade of armed conflict in the eastern part of the Democratic Republic of Congo (DRC), tens of thousands of women and girls have been subject to crimes of sexual violence and rape. It is estimated that less than half of the actual cases of rape and sexual violence are reported to authorities, and of those cases that are, even fewer women receive the services and medical care that they need.

This report is an evaluation of the Listening to Displaced Rape Survivors Project, a program which began in September 2009 and sought to provide psycho-educational workshops, or “trauma healing” teachings, to 212 women who are survivors of rape. In addition to the trauma healing teachings, the program provided listening sessions and skills-building classes to participants. The goal of the project was to “empower participants in their everyday lives, as well as create the sense that they are able to take control of their situation and direct the course of their lives.”

The evaluation demonstrated that the program succeeded in helping participants process and understand what they have experienced, as well as to accept what happened without blaming themselves. In addition, the program proved to have a positive impact on participants’ lives by creating a space where they could share their experiences with others and have a peer support group. All of these successes led participants to express a newly found hope for the possibility of a better future.

However, the evaluation also demonstrated that participants continue to experience high levels of mental distress which disrupts their day-to-day functioning, family and interpersonal relationships, and economic stability. While improved program indicators and monitoring would lead to more precise conclusions, initial interpretation of participant responses to a trauma questionnaire suggest that much of the continued distress experienced by participants is onset from widespread poverty and poor health. Therefore, the recommendations of this report include incorporating a more comprehensive approach for future programming.

Overall, the program is viewed as a success. Healing from trauma, especially in a context of continued stress and hardship, is a long and difficult process. The Listening to Displaced Rape Survivors Project has accompanied participants in taking that first step towards understanding and stepping forward. The fundamental suggestion of this report is to continue and expand program support.

Introduction

About the Listening to Displaced Rape Survivors Project

The Listening to Displaced Rape Survivors Project is a program run by the staff and volunteers of the Centre de Paix pour le Guérison et Reconstruction du Base Communautaire (CPG-RBC), under the auspices of the African Great Lakes Initiative (AGLI). The program receives support from Pennsylvania Yearly Meeting’s (PYM) Legacy Grants Group.

The Listening to Displaced Rape Survivors Project began in September 2009 after a group of former female participants in CPG-RBC’s programming approached program coordinator Zawadi Nikuze and spoke to her about the context of rape in the DRC. They appealed to her to hear their personal stories of rape and sexual violence, to help them learn to manage their trauma and to find a way of achieving socioeconomic independence.

In response to their appeals, CPG-RBC and AGLI jointly sought funding from the PYM Legacy Grants Group to bring together 300 displaced women who are survivors of rape and sexual violence to provide a series of 12 Healing and Rebuilding Our Community (HROC) workshops, in order to provide participants with a framework for understanding and managing their trauma. In addition, CPG-RBC/AGLI sought funding to provide: 1) a series of listening sessions which would give survivors a chance to explore their trauma with others and begin healing in a supportive group environment; and 2) a number of skills-building activities which would improve participants’ self-sufficiency and capacity to generate income.

The Listening to Displaced Rape Survivors Project was originally intended to take place in internally displaced persons (IDP) camps located in and around Goma, the provincial capital of North Kivu. The project focused on women survivors living in IDP camps, as these women faced increased vulnerability while living in the camps. However, at the end of September 2009, the government of the Democratic Republic of the Congo unexpectedly closed all IDP camps, violating numerous humanitarian conventions and disrupting the original project plan of the Listening to Displaced Rape Survivors Project.

With the sudden change of circumstances, it was necessary to adjust the Listening to Displaced Rape Survivors Project plan. The 300 women intended to participate in the program were scattered. Many returned to their villages, while others stayed in and around varying neighborhoods of Goma. The CPG-RBC staff managed to locate only 212 of the intended beneficiaries and found that they were living in worse conditions than while they were in the camps. The women no longer received food assistance or even the limited medical care provided previously. In addition, they were forced to find manual or casual jobs in order to provide for their families. The manual labor often exacerbated injuries caused from rape. Security issues also pushed the woman to “cohabitate” with men, even if these men were/are unreliable and abusive. The program plan was therefore changed to provide 9 HROC workshops and 20 listening sessions (instead of 12 each) to the 212 remaining participants. Literacy and basket weaving classes continued as planned.

This evaluation measures the impact of difference these interventions had on the lives of participants.

Brief History of the Conflict in Eastern Congo

Some people have called the conflict in the Democratic Republic of Congo “Africa’s World War.” Indeed, it is the deadliest international conflict since World War II. An estimated 5.4 million have died as a result of the conflict either through direct violence or the indirect consequences of war (disease, poverty, malnutrition).

Yet few people understand the nature, breadth, or history of the conflict in the eastern DRC, in part because reporters and journalists have been highly restricted and threatened in their movements. For the most part, however, the world tends to focus on the development of the conflict since 1997, even though the roots of the conflict go as far back as the Berlin Conference of 1885.

The DRC is a massive territory stretching from the Atlantic Ocean to eastern Central Africa, sharing borders with Angola, the Republic of Congo, the Central African Republic, Sudan, Uganda, Rwanda, Burundi, Tanzania, and Zambia. Its land mass is approximately equivalent to that of all of the U.S. east of the Mississippi. Yet the recent conflict in the DRC has predominantly been isolated to only the DRC’s most eastern provinces—North and South Kivu—an area just smaller than Pennsylvania.

The scramble for Africa could be labeled as the starting point for the ethnic conflict in eastern DRC today. At the Berlin Conference of 1885, European nations arbitrarily placed lines across the continent of Africa and gave power over the new nation states of Rwanda, Burundi, and what was then known as the Congo Free State to Belgium.

Today, Rwanda claims that the region of the DRC encompassing the Masisi territory, Rutshuru, all the way down to South Kivu (an area extending down to Bukavu) is historically part of the Rwandan kingdoms. Rwanda also claims portions of Uganda and Burundi. This is one dynamic at play in the conflict today.

A second dynamic at play is that throughout the early colonial period, the eastern DRC became a predominantly Hunde area due to the Belgians’ division and categorization of ethnic groups. Then, in the late 1950s, the Belgians forcefully imported Hutus from Rwanda to exploit the fertile land of the Masisi territory (the Belgians believed that the Hutus were stronger workers than the Hunde) and Tutsis to oversee the Hutus labor.

Nyamitaba in Central Masisi was the first area of forced migration by the Belgians. While it was the center of the seven surrounding villages, the importation of Hutus and Tutsis was so large that it was not long before they were the majority in the area. And because the Belgians had made a deal with the Hunde leadership prior to the forced migrations, Hutus and Tutsis were excluded from the leadership of the area.

When the Congo Free State gained independence in 1960, the new Constitution recognized all people brought over from Rwanda before 1960 as Congolese. Later, after Mubuto Sese Soko took power, they were also recognized as Zairois. However, the Hunde leadership continued to deny Hutus and Tutsis entrance into local power structures.

War broke out in 1964. It was called the War of Kinyarwanda, meaning that Hutus and Tutsis were fighting for their right to leadership in the Masisi Territory. Hutus eventually took power and declared that there would be no more fighting. As a local minister describes this period, “People kept quiet. They lived together, but like cats and dogs. They lived together because the master wanted them to, they were obligated. But by their own will, the Hutu and the Hunde would not live together,” and tensions continued to grow.

In 1977, Hutus and Tutsis were elected to the Parliament for the first time. The term was 5 years long. Upon completion of this first term, a national mandate was issued denying Hutu and Tutsi candidates’ participation in national elections; it was not until 2006 that they were again allowed to participate.

From 1982, people in the Masisi territory began to divide even more. Militias started forming and in 1993 war broke out again. Locals call this the “second phase of the war,” a continuation from 1964. The Hutu land holders formed one militia, the Pareco. The Hunde formed another militia, the Mai-Mai. After the genocide in Rwanda in 1994, the Interahamwe, or Hutu génocidaires, who fled (still armed) to Congo formed their own militia, the Democratic Forces for the Liberation of Rwanda (FDLR). The Congolese Tutsis fled to Rwanda after Paul Kagame, the leader of the Rwandan Patriotic Front (RPF), gained victory over Rwanda and welcomed back all Tutsi refugees and people. In this way, the war and conflict just kept on expanding.

In 1996, even though the international community often claims that this is where the war started, the third phase of the war began. First, militias backed by Rwanda and Uganda ousted 30-year ruler Mubutu Sese Suko in what became commonly known as the “Liberation War.” Then, after newly installed former-rebel President Laurent Kabila broke his alliance with his former backers, the Rwandan and Ugandan militaries invaded eastern DRC claiming they were looking for members of the Interahamwe, or the Rwandan génocidaires, in the “Re-Vindication War.” Locals frequently state that at this point “organized and systemic rapes and massacres began, houses were set on fire, and there was massive displacement.” The ethnic war had become an international war: Rwanda and Uganda against the Congolese army backed by Angola, Zimbabwe, and Namibia. However, as one local said, it was really “an open, ‘legitimized’ war between three ethnic groups. It was all about revenge.”

A peace agreement was signed in 2002 which supposedly brought the end to the war and the integration of militias and rebels into the national army. However, the military integration process fell apart when one rebel leader, Laurent Nkunda refused the offer to be a general in the national army and began organizing a new, predominantly Tutsi, rebel group, the National Congress for the Defense of the People (CNDP). Despite the “official” end to the war, the worst abuses of the conflict in the DRC were still to come.

The first multi-party elections in over 40 years were held in the DRC in 2006. The son of the former President, Joseph Kabila, won in the polls based on a campaign to end the violence in eastern DRC. But only months after President Kabila took office, the CNDP attacked the national army, leading to a period of even worse displacement, lootings, recruitment of child soldiers, and sexual violence.

In 2007, an attempt to “mix” the CNDP with the national army was tried and then abandoned, the only result being a quadrupling of the CNDP’s brigade size. In 2009, in a shift in former political alliances brought about by international pressure to end the conflict in North Kivu, the DRC and Rwandan militaries launched a joint offensive against the FDLR (former Rwandan génocidaires).

Today, North and South Kivu remain politically divided. The national government, CNDP, and FDLR all maintain political control over particular sectors of the provinces, especially in the Masisi territory. Six years after the war “ended,” people still live in fear. Many people living in the villages of North and South Kivu still sleep in the bush at night, only returning to their houses during the day, for fear of the militias and army which patrol the area.

Context of Rape in Eastern DRC

In the course of the conflict in the DRC, the country has become known as “the worst place to be a woman.” Since 1998, when the Rwandan and Ugandan militaries invaded eastern Congo, reports of sexual violence have been widespread and even systemic; there are tens of thousands of known rape cases and it is believed that less than half of actual rapes are reported. Human rights groups report that rape has been deliberately used on all sides “to terrorize citizens, to exert control over them, or to punish them for perceived collaboration with the enemy,” whoever the “enemy” to one particular militia or military group may be. Moreover, reports of rape have continued to rise during the peace process.

Over eighty-percent of reported rapes are attributed to soldiers (men in uniforms), even though defining who is a soldier amidst the many militias and national armies operating in the DRC is difficult. Nonetheless, it is well documented that the Congolese military (FARDC), which is meant to provide citizen protection and is backed by the United Nations, is one of the main perpetrators of systematic rape.

The physical, psychological, and emotional trauma of sexual violence and rape is overwhelming. Women, especially young girls (the UN Population Fund estimates that 65% of rapes in the DRC are against adolescent girls), frequently suffer deadly or chronic injuries due to rape. Risk of HIV and other STI transmission is also significantly greater if the rape was carried out by a soldier.

However, women and girls are not only traumatized by the act of sexual violence; they also face the negative attitudes and stigmatization of their families and communities. Families often kick young girls out of the house after they have been raped. Husbands will divorce their wives and engagements will be broken off. Women are then required to care for themselves and their children alone, which frequently makes them vulnerable to even further abuse.

Evaluation Methodology

This evaluation was jointly carried out by Alexandra Douglas and Zawadi Nikuze. Alexandra is the program manager for the Friends Women’s Association in Kamenge, Burundi, a grassroots women’s clinic which focuses on post-genocide trauma, HIV/AIDS, and sexual violence. Zawadi is the program coordinator of both the Listening to Displaced Rape Survivors Project and Healing and Rebuilding Our Community programs at the Centre du Paix pour la Guérison et Reconstruction de Base Communautaire in Goma, North Kivu.

Together, they interviewed 21 participants in the Listening to Displaced Rape Survivors Project (approximately 10% of project beneficiaries). Originally they planned to interview 27 participants, or 3 participants from each of the 9 workshops carried out; however, the number of participants interviewed was cut short for two reasons. First, on the first two days of interviews, only 8 of 9 women scheduled to be interviewed showed up. Second, the third day of interviews was cut short due to an unwarranted interruption by local officials claiming that they were not permitted to work in that sector. While the situation was cleared up after going to the Chief of Security’s office and calling the Mayor of Goma’s office, the situation caused unexpected delays. For these delays, as well as efforts to protect participants’ confidentiality (many of the participants were raped by police and other authoritative figures), Alexandra and Zawadi chose to end the day’s interviews early.

The interviews took place in the outer reaches of Goma, in an area closer to where the majority of participants live instead of the center of town. The interviews were conducted with one woman at a time in a private room in order to ensure confidentiality. Alexandra asked the questions and recorded participants’ responses while Zawadi interpreted. It is important to note the use of the term “interpretation” as opposed to “translation” as knowledge of English and Kiswahili, participants’ personal histories, and personal investment in the project undoubtedly influenced how things were said and understood.

The interview questions combined 3 types of questions (see Annex II for a copy of the interview questions) and were proceeded by an Interview Consent Agreement (see Annex I). The first 7 questions asked basic demographic information to gain a sense of participants’ socioeconomic situations. These questions were then followed by a series of open-ended programmatic questions. Questions regarding the program were intentionally left open ended in order to allow participants to reveal what was most important to them about the trauma healing teachings and to counteract the tendency of participants to state merely what they think the interviewer wishes to hear. Finally, participants were asked a 17-question trauma questionnaire adapted from the civilian PTSD Checklist (see Annex III).

The interviewers chose to use the trauma questionnaire in order to measure the indicator stated in the project proposal: “success will involve survivors feeling empowered in their everyday lives as well as the sense that they are able of taking control of their situation and direct the course of their lives”. To do this, it was necessary to measure not only whether or not participants “liked” the workshops, but whether or not the workshops and listening sessions succeeded in reducing the symptoms of debilitating mental pain that can impede day-to-day functioning, disrupt and/or destroy family relationships, and create economic hardship. The trauma questionnaire provided a way in which to measure to what extent common trauma symptoms still impeded the day to day lives of participants.

It should be noted, however, that there are several shortcomings of the trauma questionnaire. First, it was developed in a Western context which does not reflect the unique ways in which mental distress manifests itself in the DRC context. While many symptoms of trauma are similar in both contexts, some of the questions on the trauma questionnaire do not make sense in the DRC context and would be better replaced by culturally appropriate indicators, such as “thinking too much,” “withdrawing,” or “talking to myself on the road” (see Recommendations). Second, the trauma questionnaire has not been formally translated into Kiswahili and therefore was subject to the same fluctuations of interpretation mentioned above. Finally, the trauma questionnaire does not in itself reveal to what extent participants’ mental distress is a result of traumatic stress verses continuous stress, even though this often became evident in the additional comments provided by participants.

As a final note on methodology, all names, locations and other identifying factors have been omitted or changed and replaced with pseudonyms in this report. While this evaluation did not ask participants to recount their stories, identifying details of perpetrators often came out throughout the course of the interview. Rape and sexual violence continue to take place at alarmingly high rates throughout eastern Congo and, as mentioned in the previous section, over 80% of these acts of violence are carried out by men in uniform. Omissions and pseudonyms have been used in order to protect participants’ identity and to prevent potential acts of retaliation and/or stigmatization. In addition, participants’ names are kept in a separate, locked location from their interview responses and interview responses are numerically coded

Findings
Understanding, Sharing, Hoping

“I remember the definition of trauma and the causes of trauma. I remember those because I was able to identify my problems. Before I thought it was a crazy disease or witchcraft but then I saw the causes and the symptoms in my own life and knew what was happening”
- 23 year old woman

“ The sharing session was best because we were able to accept one another. Being there and listening to one another without being blamed or condemned.”
- 22 year old woman

“ The Trust Tree gave me hope for the future because before I had given up. But now I feel like I know how to pick up my broken pieces and keep going.”
- 30 year old woman

Participants’ responses to what they remembered most, liked best, or what had the greatest impact on their lives could be categorized into three overarching themes: understanding, sharing, and hoping. A common misconception in the DRC is that someone who demonstrates signs of traumatic stress is “crazy,” “bewitched,” or “possessed by demons.” For this reason, women who suffer trauma after experiencing sexual violence are often stigmatized and ostracized within their communities, even by those who have no idea what a woman has experienced. Compounded with community- and self-blame, as well as abandonment by families, spouses, and boyfriends, this feeds to the perception of a woman that she is alone, that everyone is “laughing at” or “mocking” her, and that she is at fault for what happened.
One strength of the HROC trauma healing program is that it helps women understand what trauma is and how it commonly manifests itself. The women interviewed frequently stated that after learning about the causes and symptoms of trauma, they could “identify [trauma] within” themselves, which contributed to a process of understanding and self-acceptance. Once they understood what was happening to them, it was easier to begin the process of managing their own traumatic responses and living with others.

Participants also highlighted sharing as a critical component of the Listening to Displace Rape Survivors Project. As stated above, stigma towards women survivors of sexual violence and traumatized persons often leads to the perception that one is alone in what s/he has experienced. Participants continually emphasized the importance of realizing that they were not the only woman who had been raped, or that had been raped in front of a spouse or child. The majority of women interviewed stated that listening to the stories of how other women survived gave them strength to survive and move forward as well.

This process of sharing was facilitated by the program design of the Listening to Displaced Rape Survivors Project itself. The project intentionally brought together only women who had experienced sexual violence while in their villages or in the IDP camps. In this way, the women present in each of the workshops came to the training on common ground and at least a basic level of acceptance (e.g. “it happened”) could be assumed. The program curriculum then incorporated a number of games and activities which helped build trust between group members, allowing the sharing process to take place at a deeper level. These games and activities oscillated between “light and lively” activities which make participants smile and laugh together, to more “higher risk” activities which ask participants to share deeper, personal stories.

One activity that stood out to participants was the “opening session” which asked participants to write three traumatic experiences on a piece of paper. Participants were then asked to check or underline the one experience that impacted them the most. Each person then read this experience aloud to the group or silently to herself and threw it in a fire. Watching these pieces of paper burn had numerous effects on participants. For some, it signified “letting go.” For others, it signified that they were “not alone,” that they could “sympathize with others,” or the “goodness of sharing with others.”

Finally, participants spoke of the trauma healing workshops as providing them with hope for the future. Feelings of loneliness, self-blame, and despair lead people to believe that their futures will be cut short or that nothing good will come for them. Yet activities built into the HROC workshops provided participants with an understanding of what they are experiencing and how they can move forward.

When speaking of hope, participants frequently spoke of the Trees of Mistrust/Trust as being an inspiration. This is an exercise in which the facilitator first draws a tree on a piece of newsprint and asks participants to write or say what they believe are the “roots” of mistrust in the eastern DRC. The facilitator then asks the participants to contemplate what “fruits” a tree rooted in mistrust yields. The facilitator then draws a second tree asking participants what they believe the roots of trust are. Similarly, they follow up by asking, “What are the fruits of trust?” This exercise demonstrates the cyclical nature of violence and revenge, but it also demonstrates how this cycle can be broken. As one participant described it, “The Mistrust tree shows the roots of problems and how far someone can go. But the Trust Tree gives you hope for the future and how not to think about revenge but to look for a better future.”
Overall, participants seemed pleased with the HROC workshops and believed they had a positive impact on their lives.

Looking at “Trauma Healing”

While the Listening to Displaced Rape Survivors Project clearly had a positive impact on the lives of participants, it is unclear from the evaluation what impact of difference the program had on reducing participants’ trauma symptoms. Responses to trauma questionnaire showed that the majority of women interviewed still demonstrated high levels of traumatic stress (see Annex III for the trauma questionnaire scoring mechanism). However, this does not necessarily reflect upon on the program’s trauma healing curriculum itself, but rather on how the program could be improved given the current living situations of participants in the program.
To begin with, no baseline was established before the program to measure participants’ levels of mental distress at their point of entry into the program, making it impossible to measure a reduction or increase of symptoms over the course of their participation in the program. Secondly, when responding to the trauma questionnaire, many women provided more extensive commentary of the nature of each of their responses to stress. This commentary highlights the complex nature of “trauma healing” in a place like the DR Congo.

When responding to the questionnaire, almost every woman began her answer with “it depends on my situation” or “it depends on my lifestyle” throughout the period of time being measured. In clarifying this response, women responded that their levels of mental distress corresponded to their capacity to find food, shelter, or medical care for themselves and/or their children. This demonstrates that widespread poverty and poor health are underlying causes of distress which onset traumatic responses, such as flashbacks, heart palpitations, headaches, or withdraw.

Take the following quotes as examples:

How often do you experience repeated or disturbing images, thoughts or memories of a stressful event of the past?

“ When my children have needs, it comes quickly. If I had not been abandoned by my husband, I would have someone to help care for them.”
- 47 year old woman

“ Depends on my lifestyle at that moment. Sometimes it’s good and I don’t remember what happened, but for the last month it was difficult because I was ill and couldn't do business. I feel as if my inner wounds are fresh.”
- 27 year old woman

How often do you have the feeling that you are emotionally numb or unable to have loving feelings for those close to you?

“ It depends on my situation. Even for the boy, who is a product of rape, I may beat him up and release my anger on him. I'll get caught up in my problems, thinking I can't make a better life and he'll represent so much.”
- 21 year old woman

How often do you have the feeling that your future may somehow be cut short?
“ That is often because with all of my children, no job. You're hungry, you're sick. You're carrying the whole world on your shoulder and you feel as if the world has just come to an end.”
- 40 year old woman

These responses demonstrate that the debilitating mental pain of traumatic stress still impedes participants’ day-to-day functioning, family and interpersonal relationships, and economic stability. However, these responses also demonstrate that larger structural issues create continuous distress which interact and compound participants’ responses to traumatic experiences.

Engaging in a long-term process of trauma healing with participants in the Listening to Displaced Rape Survivors Project and achieving the objective of participants “feeling empowered in their everyday lives as well as having the sense that they are able to take control of their situation and direct the course of their lives” will require much than the HROC psycho-educational programs, listening sessions, and skills building workshops. It will require a comprehensive approach which addresses participants’ intersecting needs simultaneously (see Recommendations).

Successes
Support Groups

“I like the support groups, because they really touched my heart. Knowing you are not alone strengthens you. But also having others listen to you without judgment or blame.”
-15 year old girl

“ The greatest impact is to be part of a support group and knowing how sharing in a group can offload your heart. Now I can afford a smile and I have friends who have been through the same thing and they won’t laugh at me.”
-23 year old woman

One of the greatest successes of the Listening to Displaced Rape Survivors Project is the creation and continuation of women’s support groups. After the initial workshops, women participated in both group and individual “listening sessions.” The listening sessions were an opportunity for participants to listen to one another’s problems in a group setting; the individual sessions were one-on-one with HROC program facilitators. Since these initial listening sessions, women participants have continued to meet and support one another. Zawadi Nikuze, coordinator of the program, describes this as a success because “they have a group which is there and we don’t provide them with any money or incentive to come. They come no matter what. They enjoy being together and have a great love for one another. They laugh, crack jokes, and visit each other when one is sick or in need.”

Accepting Without Blame

“Before the workshop, if someone did something wrong to me, I would think that they did it because of what happened, that they were blaming me for the rape, for the baby. I used to hold grudges, but now I can let go of things.”
- 15 year old girl

“ I used to always be broken, holding my head. I was always hungry but couldn’t eat. Always asking myself what I did to God to deserve such things. But as I said, I felt as if a tumor were cut out of me at the workshop. I don’t feel like it’s something I’ve done and am being blamed for anymore. I don’t always go around asking these questions to myself.”
- 21 year old woman

“ The greatest change was first accepting those two children [from rape]. Then after that, it was a change from always blaming myself for what happened, to now seeing myself and my children as human and having hope for the future.”
-22 year old woman

Another major success of the Listening to Displaced Rape Survivors Project is the impact it had on participants’ self-perception. Prior to the workshop, the majority of women spoke of feeling alone and blaming themselves for being raped or becoming pregnant due to rape. However, the women interviewed continually stated that after the workshop they realized that they were not to blame for what happened. While the participants continue to show high levels of mental distress, the conceptual shift from self-blame to acceptance is an important step in the process of trauma healing which has far reaching effects.

Recommendations

All participants interviewed were asked what changes they would make to the Listening to Displaced Rape Survivors Project, as well as if they had any recommendations for the program. While nearly every participant stated that they would make no changes to the HROC workshop curriculum, nearly every interviewee also offered suggestions on overall program improvement.
The most frequently cited improvement was the addition of a healthcare component to the program (15 of 21 interviewees requested healthcare). Twelve respondents requested income-generating and business planning support and 10 suggested additional skills-building classes. Other recommendations, in order of frequency mentioned, include educational support for participants who are minors and participants’ children, temporary shelter, advocacy and legal services, and programming for other key populations (participants’ families, community leaders, etc).

The recommendations below outline short-term and long-term actions which can be taken to improve general programming, impact, and fundability.

Short Term

1. Coordinate with other NGOs and service organizations to ensure that program participants have reasonable access to the following services:
a. Medical Care
b. Food Assistance
c. Legal Services
d. Education for participants who are minors and participants’ children

2. Provide small business selection, planning, and management (SPM) trainings to participants and administer accompanied micro-credit loans and skills-building programs.

3. Train participants elected from each of the women’s support groups as basic-level Community Health Workers who can provide basic nutrition and hygiene education, adherence support, and service navigation, accompaniment, and advocacy.

4. Develop program indicators and improve monitoring and evaluation mechanisms (see additional recommendations below).

5. Develop program planning with the intention of approval by an Institutional Review Board/Independent Ethics Committee (IRB/IEC) as the provision and evaluation of programs with survivors of sexual violence and rape does not fall under IRB/IEC exemptions.

Long Term

1. Provide comprehensive, gender-sensitive, single point of access care for program participants, including but not limited to:
a. Rape and sexual violence crisis counseling
b. On-going trauma healing and psychosocial support
c. Basic healthcare provision
d. Paralegal services
e. Social support, including income generation and skills-building projects
f. Temporary housing

2. Train participants as rape crisis counselors, trauma healing facilitators and community health workers to empower women as leaders within their communities and create a sustainable community resource for other women in participants’ communities.

3. Provide additional community-based trainings on sexual violence and trauma, focusing specifically on providing trauma support to the families of participants and gender-based violence education to community leaders.

Monitoring and Evaluation

1. Develop future program planning using the Casual Pathway or Logical Framework, in order to ensure that program activities form a technically and programmatically sound logical progression to achieve desired outcomes and can be measured at each step of implementation.

2. Elaborate clear and measurable indicators with which to measure the program’s impact and improve specific programming components.

3. Develop culturally appropriate trauma indicators and conduct intake (to develop a point of reference), 3-month, and 1-year surveys with participants to measure the improvement of day-to-day functioning over time.

Annex
Annex I: Interview Consent Agreement
My name is Alexandra Douglas. I work in Kamenge, Burundi at a women’s health clinic which provides primary care, with additional programming focused on post-genocide trauma, HIV/AIDS, and sexual violence. I have come to North Kivu, DRC to help AGLI and the Centre Paix pour le Guerison et Reconstruction de Base Communitaire (CPG-RBC) do an evaluation of the Listening to Displaced Rape Survivors Project. The value of an evaluation is that it helps us measure the impact that the program has had on its beneficiaries. In order to do this, we have prepared a list of questions we would like to ask participants about the project.
If it is okay, I would like to ask you these questions. Some of the questions will ask you directly about your experiences in the program. Others will ask you about the frequency at which you experience specific responses to trauma. I want you to feel free to say whatever you think or feel, I will not judge you. Your responses will only be used to evaluate the program and will not impact your current or potential future participation in the program. All of your personal information will be kept confidential. If you do not want to be interviewed, you do not have to participate. If you decide after we have begun that you do not want to participate or do not want to answer a specific question, we can stop and I will not use your information in my report.
Is it okay if I ask you some questions about the Listening to Displaced Rape Survivors Project?
Yes___ No___
Is it okay if I ask you some questions about your current responses to traumatic experiences?
Yes___ No___

Annex II: Interview Questions

Consent
SEE ANNEX I
Demographic Questions
1. Name/Participant ID Number
2. Age
3. Marital status
4. Number and Age of Children
5. Work status/ primary breadwinner
6. Where do you live?
7. Where are you from originally?
Programmatic Questions
1. When did you first participate in the program?
2. Did you participate in any of the listening sessions? If so, how many?
3. Did you participate in any of the skills building workshops? If so, which?
4. Do you receive services from any other organizations, such as food assistance, medical care, micro-credit, etc?
5. How did you first hear about the program?
6. What did you think the program was about before you participated?
7. What do you remember most about the workshop?
8. What did you like best?
9. What did you dislike?
10. Is there anything you would change about the workshop?
Trauma Questionnaire
SEE ANNEX III
Conclusion
1. Compare how you have felt over the last month with how you felt before your participation in the program. How has it changed?
2. What would you say is the greatest impact this program has had on your life?
3. Do you have any questions for us? Recommendations?

Annex III: Trauma Questionnaire

Instructions to interviewer: Below is a list of problems and complaints people sometimes have in response to stressful/traumatic life experiences. Carefully read each one aloud to the interviewee and ask them to indicate how often they have been affected by that problem in the last month.
No. Response Not at all (1) A little bit (2) Moderately (3) Quite a bit (4) Extremely (5) Comments
1 Repeated, disturbing memories, thoughts, or images
of a stressful experience from the past?
2 Repeated, disturbing dreams of a stressful
experience from the past?
3 Suddenly acting or feeling as if a stressful experience
were happening again (as if you were reliving it)?
4 Feeling very upset when something reminded you of
a stressful experience from the past?
5 Having physical reactions (e.g., heart pounding,
trouble breathing, or sweating) when something
reminded you of a stressful experience from the
past?
6 Avoid thinking about or talking about a stressful
experience from the past or avoid having feelings
related to it?
7 Avoid activities or situations because they remind
you of a stressful experience from the past?
8 Trouble remembering important parts of a stressful
experience from the past?
9 Loss of interest in things that you used to enjoy?
10 Feeling distant or cut off from other people?
11 Feeling emotionally numb or being unable to have
loving feelings for those close to you?
12 Feeling as if your future will somehow be cut short?
13 Trouble falling or staying asleep?
14 Feeling irritable or having angry outbursts?
15 Having difficulty concentrating?
16 Being “super alert” or watchful on guard?
17 Feeling jumpy or easily startled?
Source: PCL-M for DSM-IV (11/1/94) Weathers, Litz, Huska, & Keane National Center for PTSD - Behavioral Science Division.

How is the Trauma Questionnaire scored?

1) Add up all items for a total severity score

Or

2) Treat response categories 3–5 (Moderately or above) as symptomatic and responses
1–2 (below Moderately) as non-symptomatic, then use the following DSM criteria for a
diagnosis:
- Symptomatic response to at least 1 “B” item (Questions 1–5),
- Symptomatic response to at least 3 “C” items (Questions 6–12), and
- Symptomatic response to at least 2 “D” items (Questions 13–17)