KIWANJA, Congo | Rape has been a tool of war throughout human history, but rarely in modern times have its practitioners been so cruel, indiscriminate or pervasive.
In eastern Congo, victims as young as 3 and as old as 67 are turning up in clinics with similar injuries from brutal sexual assaults.
"They dragged two of us into the bush," 5-year-old Antoinetta Borauzema said in the softest of whispers as she recalled her recent abduction and rape by an armed man. Peeking out at visitors to a local shelter from behind her hands, she said, "He lay on top of me. It hurt."
Doctors say girls and boys have survived horrific violence, attacks that will affect them physically and psychologically for the rest of their lives. Some rebel groups seek out children, raping them when they are alone in the fields or even snatching them from the arms of screaming parents, who are helpless to defend them.
The Washington Times spent six weeks in Congo earlier this year to investigate the causes of this epidemic, a human rights atrocity so grave that Hillary Rodham Clinton made Congo a major stop last month on her first trip to Africa as secretary of state.
In a country plagued by violence for decades - about 5 million people have died since 1998 from civil war or poverty-related diseases - rape has little to do with sexual pleasure and everything to do with power.
Gang rape has replaced looting and pillaging as the chosen weapon of social terror because it is more effective in destroying families, villages and tribes. Worse, the practice is spreading among demobilized soldiers and civilian men.
"It is more dangerous to be a woman than a soldier here," said Christine Deschryver, Congo coordinator for V-Day, a U.S.-based campaign against sexual violence. "It is the impunity of soldiers and former soldiers who know they will not be punished."
In this mineral-rich country - a former Belgian colony that has rarely known peace - the central government in Kinshasa rules in many places in name only. Congo's eastern provinces have been particularly lawless, overrun by fighters who surged into the country as neighboring Rwanda's genocide ended more than a decade ago.
Government forces have made a concerted effort in the past year to regain control of the east, but this has had the perverse effect of escalating the internal displacement of people and making them more vulnerable to rape and other violence.
Throughout the area, women are now afraid to work in the fields or gather firewood from the jungle - even in a group. Women and girls have been carried away to be used as sex slaves by soldiers or forced to be "bush wives" for officers.
Ugenimana Dometile, 65, has rheumy eyes and a deeply wrinkled face. In a country where life expectancy is just 48, she should be commanding respect in her community. Instead, she was raped by two militiamen and left for dead. "They broke into our house and looted everything. I tried to run away, but I fell and so they caught me," she said. She looked away and shrugged her bony shoulders ever so slowly.
Interviewed at a shelter where she has come to regain her strength and undergo surgery, she mostly sits on the front porch or looks after abandoned children who are the unwanted results of rapes.
History of terror
Rape has a long and terrible history in Congo. In the 18th century, slavers used Congolese women for pleasure on the way to the slave ships. Belgian colonists continued the practice and brought other horrible punishments, such as flaying naked Congolese with leather straps, killing children before their parents' eyes and forcing slaves to carry heavy loads until they dropped exhausted by the sides of roads.
Congo has not fared much better since independence in 1960. Longtime dictator Mobutu Sese Seko, who had the country renamed Zaire, allowed his soldiers plenty of latitude in enforcing his 32-year rule.
The aftermath of the 1994 Rwandan genocide was particularly damaging to the country. Ethnic Tutsi and Hutu militias - members of the same ethnic groups that had violently clashed in Rwanda - crossed into North and South Kivu, eastern Congo's lush lake region, and continued their carnage. Women again suffered as soldiers and militiamen roamed the region unchecked.
As Mobutu lay dying in 1997, Rwanda invaded to crush extremist Hutu militias. That invasion strengthened anti-Mobutu Congolese militias, who raced through the countryside like a spear through fish, taking food, women and commodities as they advanced on Kinshasa.
Meeting little resistance from Mobutu's army, they captured the capital, installed Laurent Kabila as president and renamed the country Congo.
Congo then became a vast battlefield for a proxy war in which Angola, Namibia and Zimbabwe backed Mr. Kabila, while Rwanda and Uganda backed militias that had turned against Mr. Kabila. Mr. Kabila was assassinated in 2001 and replaced by his son, Joseph. The conflict, often called Africa's world war, resulted in 3 million deaths during a five-year period that was to have ended with a peace deal in 2003.
Today's fighting, however, represents a continuation of that conflict, with rival militias and government troops battling for control of the mineral-rich east.
The rape epidemic has been compounded in some ways by international efforts to aid the hundreds of thousands of Congolese displaced by the fighting. Since January, 1.7 million Kivu civilians have been displaced, according to the United Nations. Many wind up in camps where the rapes continue.
Although no one knows for sure how many in this country of 67 million are rape victims, the United Nations estimates that 200,000 women have been raped in the past decade and that 40 women a day are raped in South Kivu alone.
Doctors and relief workers say the chronic need for treatment of all kinds far exceeds their capacity to help.
The damage done to the victims is far more than physical. In a classic blame-the-victim syndrome, many Congolese men shun their wives for being raped, saying they are obliged to send them away because the women have been "unfaithful." Many rape victims are afraid to return to their villages for fear of being shunned or expelled, a near death sentence in a culture that strongly favors family.
"Rape is not about sex, but power, terror. And that is exactly how it's being used in the Congo," said New York filmmaker Lisa F. Jackson, whose graphic and grueling 2008 documentary about Congo's sexual violence, "The Greatest Silence," is to be broadcast on Congolese television.
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.
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.
Kinshasa's policy of inducting thousands of rebels into the ill-equipped and poorly trained army as a way of spreading peace may be making the situation worse, said U.N. officials and other Congo specialists.
The army, known by its French acronym FARDC, has been responsible for hundreds of cases of sexual violence, according to a July report by Human Rights Watch.
"The local civilians continue to suffer from widespread instances of rape by the Congolese forces," said the report, which analyzed human rights violations in the Kivus. Researchers say the number of rapes has doubled and sometimes even tripled across the region since military operations began in January.
The culture of impunity and cruelty also has infected U.N. peacekeepers, about 16,000 of whom are deployed in eastern Congo with a mandate to protect civilians.
Beyond the law
Soldiers and civilian workers with the peacekeeping mission, known as MONUC, have been accused of sexual exploitation and abuse, although not gang rapes, as U.N. officials are quick to point out. Among the offenses: sex with "willing" minors and prostitutes, and trading food and shelter for sex.
Commanders acknowledge the discipline problems, but U.N. rules allow them only to send misbehaving troops home to be tried by their own governments. About 100 peacekeepers have been repatriated to their home countries, officials say.
The United Nations rarely publicizes the infractions because, diplomats say, there is no point in antagonizing countries that are physically or fiscally supportive of peacekeeping.
Congolese officials, U.N. peacekeepers, politicians, international aid workers and rape victims agree that the biggest problem is the lack of punishment. Congo's undertrained, undermanned police force cannot catch the perpetrators, nor bring them to justice. The national army has similar problems.
Evidence is rarely gathered. Judges are bought cheaply. And courts are mired in backlog. In a country where more than 80 percent live below the poverty line, many women simply cannot afford the time or $40 court fee for a trial.
On top of that, women must be able to name and identify their attackers, which is often impossible if the rapist was a soldier or rebel. Victims also risk public shaming by merely discussing sex and violence.
Meanwhile, scores of women and children gather at places of refuge such as those run by Heal Africa, a Christian group that provides medical and social rehabilitation at seven centers in eastern Congo.
Five-year-old Antoinetta is among them. Joseph Ciza, director of Heal Africa's children's program, said Antoinetta likely would need surgery and plenty of psychological counseling to help her grow into a secure, loving and confident adult.
Children who survive traumatic sexual experiences often become oversexed themselves, he said. Boys are far more likely to become sexual predators, while girls who have been raped may turn to prostitution even before they have grown into their adult bodies.
"Rape by one man is one thing, but seven, eight, nine - that's quite another," said Virginie Mumbere, an administrator at Heal Africa. "It breaks your heart to see how many need so much help."
• Cassie Fleming in Washington contributed to this report.