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Dozens of doctors, lawyers, activists and survivors have launched programs to deal with the epidemic. All agree on the need to professionalize Congo’s police, courts and military to decrease the impunity that allows rapists to thrive.

Women’s advocates praise the Congolese government for new laws that seek to punish sexual violence, but note that these laws are rarely enforced. Nonetheless, women have been slowly pressing civil and criminal trials, often with the help of foreign organizations.

“There are so many obstacles to women who want to press charges,” said Anna Ridout, Congo coordinator for the U.S. relief group World Vision. “There is the embarrassment, of course. But this is not a very legal culture out here, and the courts are not a familiar place for most [rural women].”

Others here deal with the traumatic physical effects of repeated rapes.

Until this decade, the condition known as fistula - a rough tearing of the vagina, bladder, anus and nearby muscles - plagued small-boned and malnourished women who were trying to give birth to babies too large to squeeze beyond the pelvic ring. Today, doctors estimate, more fistula surgeries are performed on women who have been gang-raped or otherwise assaulted than on those who have undergone difficult births.

Only a handful of hospitals in the region can take on the challenge of repairing women who have been severely assaulted sexually. The damage to delicate tissue and organs is often extensive and complicated. Women and children - and sometimes, men - have endured penetration with tree branches, sticks, bottles, rifle barrels, hot coals and anything else at hand.

In some cases, women have been shot in the vagina after gang rapes.

Rapists’ signature

The result for women and girls is injury so savage that, if left unrepaired, sentences victims to a lifetime of infection, incontinence and isolation.

Denis Mukwege, a soft-spoken obstetrician-gynecologist, runs Panzi Hospital, the first fistula center in Congo. The Bukavu facility treats victims and trains doctors to repair the torn tissue. Fistula sufferers may stay there for months, first strengthening their bodies to survive the surgery and then spending weeks on a catheter to make sure they heal properly.

Dr. Mukwege, who sometimes performs 10 fistula surgeries in a day, said he can identify rapists by the wounds they leave behind.

“I can tell which group it was who did it, even before she tells me,” he said. “Some use knives, fire, [assault] only the young, a bullet. This way, it is like they leave a signature on the body.”

Quasi-governmental militias traditionally have been the worst violators. Members of one group, the Mayi-Mayis, are said to believe that raping a women will make them stronger in battle.

Two other militias, known by their French acronyms as CNDP and FDLR, have been waging a turf war between Congo and Rwanda and see rape as a powerful way to undermine Congolese communities.

Even more terrifying for women is that they cannot rely on the Congolese national army to protect them.

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