This
 document
 describes
 one
 of
 the
 necessary
 steps
 towards
 peace
 and
 stability
 in
 the
 DRC.
 Because
 of
 the
 war
 in
 the
 DRC,
 with
 thousands
 and
 thousands
 of
 women
 of
 all
 ages,
 being
 raped
 in
 the
 most
 horrible
 way,
 we
 know
 that
 health
 care
 is
 not
 enough
 to
 rebuild
 the
 hope
 and
 the
 strength
 of
 the
 population.
 The
 affected
 women
 and
 their
 families
 need
 trauma
 therapy.
 Health
 care
 personnel,
 social
 workers,
 policemen,
 military
 as
 well
 as
 and
 other
 officials
 should
 be
 prepared
 for
 meeting
 and
 treating
 the
 affected
 families,
 without
 adding
 to
 the 
stigma 
and 
trauma.

 The
 project
 is
 initiated
 by
 Dr
 Mukwege,
 through
 the
 international
 network
 Yennenga
 Progress
 (www.yennengaprogress.se).
 To
 be
 able
 to
 spread
 knowledge
 and
 the
 trauma
 therapy
 method
 over
 a
 vast
 area
 of
 inaccessible
 land
 to
 a
 large
 number
 of
 affected
 people,
 an
 e‐learning
 tool
 will
 be
 produced
 in
 cooperation
 with
 MKFC.
 The
 psychological
 expertise
 is
 guaranteed
 by
 the
 Swedish
 CBT‐institute,
 in
 collaboration
 with
 the
 institute
 for
 crisis
 management 
at 
Uppsala 
University.


1.
Mukwege Foundation
The Treatment of Trauma
‐ Women and their Families in DRC

2. Table of Contents
Introduction ......................................................................................................................................3
Project aim....................................................................................................................................3
Methods and Techniques..................................................................................................................4
Information and Communication Technology (ICT) ...................................................................5
Project Activities ..........................................................................................................................5
Treating Trauma Post-Traumatic Stress Disorder (PTSD) ..........................................................6
Organisations Involved in the Project ..............................................................................................9
The network Yennenga Progress..................................................................................................9
Mukwege Foundation.................................................................................................................10
MKFC Stockholm College.........................................................................................................11
Svenska KBT Institutet (SKBTI) ...............................................................................................12
Management of the Project ............................................................................................................12
Project objective.........................................................................................................................12
Sustainability Plan......................................................................................................................13
Project Indicators........................................................................................................................13
Risk factors.................................................................................................................................13
Coordination...............................................................................................................................14
Democracy and human rights in the project...............................................................................14
The Democratic Republic of Congo – Background Information About the Social Situation........15
Context .......................................................................................................................................15
Democracy and human rights.....................................................................................................15
Gender ........................................................................................................................................16
Resources ...................................................................................................................................16
Opportunities (e.g. education, employment)..............................................................................16

3. Introduction
“Right now there's a war taking place in the heart of Africa, in the Democratic Republic of
Congo (DRC), and more people have died there than in Iraq, Afghanistan, and Darfur
combined.
You probably haven't heard much about it, but as CNN's Anderson Cooper first reported last
January, it's the deadliest conflict since World War II. Within the last ten years, more than
five million people have died and the numbers keep rising.
It is, in fact, a war against women, and the weapon used to destroy them, their families and
whole communities, is rape.”[1]
Quotas from 60 minutes
This document describes one of the necessary steps towards peace and stability in the DRC.
Because of the war in the DRC, with thousands and thousands of women of all ages, being
raped in the most horrible way, we know that health care is not enough to rebuild the hope
and the strength of the population. The affected women and their families need trauma
therapy. Health care personnel, social workers, policemen, military as well as and other
officials should be prepared for meeting and treating the affected families, without adding
to the stigma and trauma.
The project is initiated by Dr Mukwege, through the international network Yennenga
Progress (www.yennengaprogress.se). To be able to spread knowledge and the trauma
therapy method over a vast area of inaccessible land to a large number of affected people,
an e‐learning tool will be produced in cooperation with MKFC. The psychological expertise is
guaranteed by the Swedish CBT‐institute, in collaboration with the institute for crisis
management at Uppsala University.
Project aim
The DRC has met important difficulties during this long and terrifying war. The infrastructure
and national institutions cannot meet the needs of the population. The civil society is
therefore crucial for the development of the country, both regarding health, education and
development work. Dr Mukwege and his crew have been working actively in the Kivu
province for many years. They are well known and have a reputation among the population
as genuine helpers of women in distress. They have both the theoretical knowledge and the
experience needed to carry out its work.
Because of the difficult political situation in the DRC, with thousands and thousands of
women of all ages being raped in the most horrible way, we need to make it possible to give
the women affected, as well as their families, psychological treatment. We need to educate
social workers, hospital personnel and other officials on the subject on meeting the special
needs of the violated women and their families.

4. The victims are spread over a big geographical area, which makes it necessary to extend
these services beyond the established health care facilities in urban areas, e.g. the Panzi
Hospital in Bukavu where Dr. Mukweges team is based.
Dr Mukwege sees an urgent need for an expansive treatment and competence building. We
are therefore creating a project aiming at spreading trauma therapeutic knowledge to a
large number of people in a short period of time.
This will be done in a series of steps:
• Creating an e‐learning program with movies, voice and pictures, as well as written
text. (Learning by doing/seeing)
• Training of 10 educators, who through an educational program will provide nurses
and social workers at hospitals and clinics in the area with the tools and the
knowledge on how to professionally conduct trauma healing for affected individuals,
and how to make a first analysis of the needs of the survivor of rape. (Each educator
will need a portable computer or smart phone, to be able to show movies and use
the material.)
• Creating films and material aimed directly at the women, encouraging them to take
part in the treatment and to be used during treatment.
• Creating a manual for trauma therapy. The manual allows for staff with limited
training and experience on trauma healing to apply the method.
• Conduct research on trauma therapy and gender issues in conflict situations.
The psychiatrist at Mukwege Foundation is responsible for the coordination and the
structure of education of all persons working with the survivors of rape and their families.
The work is being done through cooperation between Yennenga Progress, MKFC and SKBTI.
During the first stage of the project, the pilot project, 10 educators (psychologists, social
workers or other health workers) will be trained in the methods of trauma therapy and
pedagogy, to be able to become educators.
During the second stage, when the methods are tested and modified, 500 persons will be
trained to be able to conduct trauma therapy, following a given method.
We are training both men and women. These will most probably treat men as well as
women, as the whole family is affected, not only the raped person needs therapy.
The target group consists mostly of rural persons, living in the countryside, working with
agriculture. Their economic situation is difficult and fragile. The fact of being raped has put
the women and their families in an even more difficult social situation.
The educators will also train official personnel such as health care workers and the police on
how to work with the affected persons without adding to the stigma of the rape.
Methods and Techniques

5. Information and Communication Technology (ICT)
Equal opportunities for knowledge building regardless of wealth, sex, religion or ethnicity
are possible thanks to Information and Communication Technology (ICT). Development and
the opportunity to spread the formal and informal learning based on best practice are linked
to the local society with ICT. The cost‐effectiveness that this creates provides financial
opportunities for new reforms and sustainability in the country.
ICT has been used in education for more than two decades. Advances in hardware, software
and networks have further enhanced the potential of ICT. At the same time systematic and
strategic factors affecting ICT development in informal education. ICT is an important tool to
communicate about changes, where all citizens can participate and make their voice heard
through social networks.
Educations supported by ICT are crucial for making long‐term changes. A developed ICT
community as Sweden can build a bridge to developing communities and share knowledge
of good practices.
• ICT creates opportunities for everyone to receive, create and disseminate
information in local environments
• ICT enables people to increase their participation in learning and decision‐making
• ICT for training tutors is cost effective and helps young people create jobs and
teaches them how to apply entrepreneurial thinking to their future workplace. The
result is a more robust community.
Project Activities
The therapist and the counsellors, their local contacts and understanding of the problems
and the course material are central for a successful implementation of the project.
Subject experts, e‐pedagogy experts and local experts from Sweden and the DRC are
creating the educational program and packaging it on an Learning Management System with
movies, voices, illustrations and pictures (on USBs) as well as written text with exercises
based on active learning methods as for example role‐plays.
All programme modules are digital and divided into units and facilitated in the LMS. The
modules can be distributed to laptop computers, mobile devices such as mobile phones or
iPods, USB memory sticks, printed to paper depending on ICT infrastructure.
Planning and local adjustments of the Program: The educational program is tested on
patients at the Panzi Hospital Centre and is modified based on local needs.
A computer with Internet connection and printer is installed at the Panzi Hospital Centre
together with one smart phone. The Panzi Hospital Centre works as a computer and
communication centre in the project. The therapist and the counsellors at the Panzi Hospital
Centre will get training in basic computer and mobile phone skills including Internet skills,
training in the Learning Management System (LMS), training on how to use the material,
pedagogical structure of the training programme and social studies of meeting traumatised
people.

6. Each of the ten councellors is using an Internet connected laptop (GPRS, mobile broadband,
satellite or dial up) computer and/or a smart phone when carrying out the course. This
mobile device has to be chargeable by solar energy since there is no electricity in many of
the areas where the counsellors are going to operate.
The counsellors are showing and use the material on the mobile devices. The mobile devices
are also used for two ways communicating with experts in Sweden and the DRC by voice,
video and text. Appropriate materials are handed out on site as paper copies; these can be
checklists, manuals and guides for the treated patients for self help when the counsellors
have left.
Counsellors go out to the field and implement the project to the target groups, continually
communicating with therapists and experts on phone, e‐mail and video communication
when necessary (through Skype or mobile phones).
Evaluation of the first phase of the project
Final report
Forms for continuation and ownership of the project
Treating Trauma Post‐Traumatic Stress Disorder (PTSD)
Who is affected?
A person who has been through a traumatic event in which both 1 and 2:
A.
1. The person experienced, witnessed or was confronted with an event involving actual
or threatened death or serious injury, or a threat to one's own or others' physical
integrity.
2. The person's response involved intense fear, helplessness or horror.
B.
The traumatic event is experienced at least in one of five ways (recurring painful memories /
thoughts, nightmares, a feeling that relive the event / flashbacks / hallucinations, intense
psychological discomfort for internal / external signals reminiscent of the incident and
physiological responses to signals that symbolize the event ).
C.
The individual avoids constant stimuli associated with trauma or presents a general blunting
of the ability to react emotionally as manifested by at least three of seven ways (active
avoidance of thoughts, feelings or conversations associated with trauma, active avoidance of
activities, places or people that remind about the trauma, inability to recall an important
aspect of the event, clearly reduced involvement / interest in important activities, feeling of
apathy / alienation from others, constricted affect, and feeling that no future).

7.
D.
Persistence of signs of exaltation as manifested by at least two out of five ways (difficulty
falling asleep or restless sleep, irritability / anger, difficulty concentrating, hypervigilance and
exaggerated startle response).
E.
Malfunction duration is at least a month with symptoms in B, C and D.
F.
The disturbance causes clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
Prevalence
Population prevalence of PTSD in Sweden is about 5.6% (2005). In other countries where the
population is exposed to persistent violence and systematic abuse, the estimated prevalence
is obviously much higher, but often missing the diagnosis and study of prevalence in these
countries. For example, prevalence of 32.3% among 6‐18‐year‐olds in Iraqi Kurdistan (2005)
and the frequency of PTSD in 78% of the military operation in Iraq (2000) with a follow‐up
time in five years.
Point prevalence studies conducted in the United States and Sweden have shown that the
prevalence of PTSD in women exposed to trauma were higher (12,4‐17,8%) among female
victims of assault, rape or other sexual abuse than those with non‐violent traumas where
prevalence was 3.4%. Another study found that violent trauma (threats with weapons,
physical assault and rape) were associated with 32‐46% risk of developing PTSD in women.
Risk and protective factors
Time, factors:
Before the trauma (vulnerability): Past mental illness, previous psychological trauma,
hereditary, burden of mental illness, sex, social status, education level, mental preparation.
During the trauma: the severity, duration and cognitive factors affecting how the individual
interprets the event, eg feelings of helplessness.
After the trauma: Equity and social networking.
Treatment
The CBT model that has the strongest research support for the group of patients the
treatment will be aimed at, is Foa & Rothbaums emotional processing theory (Treating the
trauma of rape: Cognitive behavioral therapy for PTSD).
This is based on the conclusion that people who develop chronic PTSD have a memory
structure of trauma involving disproportionately strong responses (such as fear,
physiological responses and avoidance) in confrontation with stimuli reminiscent of trauma.
Three main elements are included in treatment: exposure in terms of performance re‐

8. experiencing, and often on‐site visits for trauma, cognitive restructuring to change the
problematic assessment of the patient, and stress control training (including relaxation).
Important principles in the treatment
Treatment aims to change factors the suppression of ideas, selective attention to threat,
safety behaviors, avoidance of reminders of the trauma, physical tension / difficulty sleeping
and brooding about the trauma. V
In PTSD in general and for PTSD as a result of rape or sexual assault in particular, it is
extremely important that the therapist has a very accepting and validating attitude towards
the patient to show that he or her accept, understands and is able to hear everything that
the patient will tell about the trauma.
It is particularly important to strengthen the patient for what he or she did during the
trauma, in order to reduce their problematic assessments about what they should have
done differently, to prevent what happened.
Reactions of shame and guilt are often reinforced by negative responses from other people
trying to give the victim some of the blame for what happened.
Treatment step by step
1. Behavior Analysis for gathering information about what happened. Note the
importance of the therapist's approach to increase the likelihood that the patient
should dare to tell what happened. Major emphasis should be placed on the
identification and mapping of dysfunctional assumptions and negative thoughts
about oneself, evasions, and safety behaviors.
2. Measuring the prevalence of PTSD‐related symptoms and psychopathology using
self‐rating scales and clinical interview.
3. Rational for the treatment, as for all exposure treatment, it is important to
emphasize that nothing will happen against the patient's will. The exposure, ie the
imaginary reliving force, will occur gradually and completely in agreement with the
patient. It should prepare the patient for that the presence of strong emotions are
normal. Great importance should also be given to explaining what anxiety is and that
strong anxiety reactions subside and are completely harmless.
4. Psychoeducation about trauma, normal acute reactions arising and development of
more chronic PTSD, in order to help the patient understand, accept and normalize
their reactions and behaviours.
5. Exposure Treatment in the form of performance‐rate / imaginary exposure with the
goal that the patient should be able to have thoughts about the trauma, to talk about
it and be aware of trigger stimuli without experiencing intense fear and anxiety. The
treatment involves to gradually move closer to the memory of the trauma by talking
about it and provide increasingly specific questions. The purpose of this is to
reconstruct the incident / make it less fragmented and linking the most traumatic
moment (eg, "I thought they would kill me") with the actual outcome ( "I survived,
after all, and sitting here today"). This exposure also increases the possibility of

9. access the patients problematic assessments of trauma which is processed in phase
cognitive restructuring.
6. Cognitive restructuring with the goal of the patient to identify, challenge and modify
negative thoughts and assumptions that perpetuate PTSD‐symptoms. When the
specific negative thoughts have been identified, the patient can summarized them
into dysfunctional assumptions, such that other people in general are evil and
untrustworthy, that they themselves can not handle difficult situations in an
adequate manner, etc.
7. Stress Control Training.
Organisations Involved in the Project
The network Yennenga Progress
Yennenga Progress, High Professionals Development Club, is an organization based on a
worldwide network of members with a high knowledge and experience. By sharing their
connections, networks, methods and perspectives, they can provide consulting and support
for project development and fundraising. Using an expression from the business world, we
give Yennenga Progress the subtitle High Professionals Development Club.
With the desire to further develop the high level of competence and expertise that we have
encountered around the world, and after having done development cooperation work with
several organizations in Burkina Faso in West Africa, Yennenga Progress was created in
Sweden. Yennenga Progress will enable for the resources in the newtork to be used in a
creative way and facilitate the administration of the network, as well as the projects that
Yennenga Progress manage. Another priority is to document and share the experience that
the network is gaining in the process of development cooperation work.
The projects Yennenga Progress works with are initiated by our members. This guarantees
that the real issues are addressed and avoids a top‐down approach. It gives us, as an
organisation/network, a close relation to all activities undertaken; it guarantees equality in
the work method (avoids donor/receiver imbalance) and it helps people grow through
networking, exchange of experience and new friendships.
By connecting members of the network with a variety of professional skills, we develop new
ways of creating more efficient methods for project implementation. Lessons learned in one
project specializing in a certain type of development cooperation can be transmitted to
other projects linked to the network. Thus the quality of the process and methods are
increased. To learn more about the Yennenga Progress network and our projects, please visit
www.yennengaprogress.se

10. Mukwege Foundation
One of the Yennenga Progress network’s prominent members is Dr Mukwege. Dr. Denis
Mukwege is the director of the Panzi Hospital in eastern DR Congo. He is the chief surgeon,
and has become one of the world's leading experts on how to repair the internal physical
damage caused by the gang rapes used as a strategic weapon of war.
For his important work and enormous courage, he has received numerous prizes and
awards. To mention some, Dr Mukwege last year received The Olof Palme Prize, he was
awarded African of the Year, by Daily Trust, and he received the UN Human Rights prize.
Mukwege Foundation is an organisation created by Dr Mukwege and the people around him
to meet the needs of the population, effected by the horrible fact of rape as a war mass
destruction weapon. Dr Mukwege is working hard at the Panzi Hospital to heal the raped
women by giving the medical aid and performing the necessary surgical nterventions. The
work is not over when the physical problems are met. It is a long process of psychological
healing as well as social reintegration.
The main goals of the organization, Mukwege Foundation, is to put in place the professional
team needed to organize and administrate the long term projects, taking action to give the
tools needed for the women and their families to take control over their own lives, and
giving the women and their families the support needed to reunite and build a new future
together. Organize lobbying and legal actions to prevent further violence.
Mukwege Foundation is well aware that the very unstable political situation in DRC, makes it
hard to count on the government to meet the needs of the population. Civil society has a
crucial role to play for the development of the country.
There is a close collaboration both with national and international aid organizations, to
complement each other to meet the needs of the population.
This is one of the reasons why Mukwege Foundation has been created. Dr Mukwege is a well
known actor on the humanitarian field. Many organizations address him to support his
important work. This poses a grand demand on administration and coordination. The
mission of Dr Mukwege is to take care of his patients, and he is well aware of the needs they
have when they are physically ready to leave the hospital. There is a lack of professional
personnel around Dr Mukwege, to take care of the important questions that must be run
parallel: social support, psychological help, and legal support, as well as peace building and
conflict prevention.
The need for de‐traumatisation services of this kind is also highly expressed by the
population, men as well as women (source: ACT Forum Evaluation on Psychosocial Needs
and Resources in North Kivu, February 2009). The population notices that many people
affected by the war, e.g. in the form of rapes, has changed their behaviour and become
more depressed or withdrawn and are not able to attend to their normal chores. People in
the Kivu provinces put much faith in tangible medical treatment, such as medicines and
vaccines. With positive examples of activities by organizations in the provinces and evidence
of persons being healed through psychological treatment, more faith is put in such methods.
There is a great demand for distraction and access to entertainment or events, such as
sports or cultural events, which break the routine and thus increase the general well‐being

11. of entire communities. Mukwege Foundation providing healing on a psychological and social
level, the populations will be aided to live out their full potential and allow all members of
society to be valuable and contribute to the development of their communities.
Mukwege Foundation as a member of the Yennenga Progress network:
Through the membership of Dr Mukwege, the Yennenga Progress network can benefit from
the knowledge and experience of Mukwege Foundation and in return offer: (1) the exchange
and support from the members of Yennenga Progress, active in the touched fields of need
(Trauma Therapy and psychology) to the staff of the Mukwege Foundation, (2) financial
support for capacity building, and support to the development projects initiated by
Mukwege Foundation.
Projects and needs are addressed by Dr Mukwege and his crew in Bukavu. At the Yennenga
Progress level, contacts are taken with member experts in the field requested, to discuss and
exchange on possible solutions to the problem, and to connect with people, enterprises or
organizations that may correspond to the expressed need. The decisions are taken by Dr
Mukwege and his crew in Bukavu, as only they are the true experts on their own context.
Here, the two member organizations in the network involved in this project are presented:
MKFC Stockholm College
The Multicultural Popular Education Centre (MKFC) Stockholm College is based in Sweden
with a branch in Finland. Its origins are in the inclusive Nordic education system. Education
in the Nordic countries is free and includes all age groups and education levels. MKFC
belongs to a popular adult education movement originating in the grassroots movements
and supported by state funds. This Nordic education tradition has supported MKFC in
designing a roadmap to creating inclusive, sustainable development and economic growth
driven by education.
MKFC moved all of its courses online in 2001. MKFC Stockholm College uses “End‐To‐End
eLearning” for its global ICT4D mission. This means that the whole learning process is online,
from course content and student support to feedback. Our passion is to support and offer
sustainable life skills to citizens. For us education is a central means to this end. Flexibility is
one of the basic characteristics of eLearning. It can be adjusted to local requests and to new
demands the workers in authentic environment need answers to. Therefore, eLearning is an
indispensable part of this mission: it needs to be part of both educational policy and
practice.
MKFC Stockholm College supports inclusive learning and believes that in a knowledge
society education must support people’s capacity to change and innovate. At the core of our
education programmes are the Millennium Development Goals (MDGs), we support
grassroots movements for sustainable changes. Participants, that is, students, tutors and
members of local communities, are the Change Makers. They realize, build up and innovate
in line with the Nobel Prize winner Amartya Sen’s Capability Approach. Today we work with
eLearning and sustainable development in Eritrea, Somalia, Pakistan, Ghana, Tanzania,
Zambia, Kenya, Sweden and Finland.

12.
MKFC Stockholm College teachers use Information and Communication Technology for
Development (ICT4D). The goals for our eLearning ICT4D strategy are:
• No more isolation
• Equal education standard for all
• Learning in an authentic environment
• Health awareness on the grassroots level
• Decrease the costs for education
MKFC’s role in this project is to package the courses to fit the eLearning approach connected
with local implementation and technical and pedagogical support during the project.
Svenska KBT Institutet (SKBTI)
The private company “The Swedish CBT Institute” was founded 1999. The company gives
specialist treatment to people suffering from psychological and related problems. Treatment
is given by therapists working with the psychological method Cognitive Behavior Terapy
(CBT). CBT consists of a wide range of methods and interventions, mainly based on learning
theory. It is an evidence based method that today is State of the Art regarding treating
different psychological problems.
All therapists have long term experience of working within a wide spectrum of psychological
areas and also within the educational field. Of special interest for this project is the
company´s experience from treating PTSD and to give interventions for crisis. Two of the
therapists has also conducted studies and implemented manual based treatments
administered by computer or internet (Information and Communication Technology (ICT).
Svenska KBT Institutet takes part in this project by:
Supporting the project direct by taking a active role in management,
Providing the most suitable guidelines for treating PTSD, through cooperation with
specialists and scientist in the field,
SKBTI will together with MKFC ensure that the guidelines are being transformed into a
helpful e‐learning method to treat PTSD for the target groups, and give methodological and
implementation support to the staff and administrators of this project.
Management of the Project
Project objective
The Mukwege Foundation is an established and well functioning structure. The successful
recruitment of an expert psychologist is done, having the professional skills needed and the
capacity of meeting the women and families affected, conducting trauma therapy, educating
educators as well as policemen, military, and health personnel. The Foundation will also
conduct research in the area of gender based violence.

13.
Meetings, exchange of ideas, and professional support on project management and
organizational development, has resulted in clear structures, infrastructure and working
methods, to facilitate the goal of improvement of the life situation in the Kivu Province of
DRC, diminishing the stigma of the rapes and violence.
The international network of Yennenga Progress, is able to support the psychologist and the
team at the Mukwege Foundation as well as contribute to debriefing, and make use of the
experience of the Mukwege Foundation psychologist to open doors internationally, for the
positive change.
Sustainability Plan
The material will be available after the project and the counsellors participating in the
project are able to educate and tutor new counsellors with help of the acquired knowledge
from the project, old and new contacts and with the help from the Hospital centre.
By using the method of e‐learning, counsellors can bring new courses and educations to the
rural areas and such as vocational trainings, community action projects, microcredit, teacher
training, entrepreneurship etc., helping entire communities achieve sustainable
development. This can also be applied to the treated women and families who can’t return
home. By studying at a computer centre connected to the hospital, these persons can get an
education without attending a school, and work at the same time.
Project Indicators
• A skilled psychologist is employed in Bukavu.
• The experts from the Yennenga Progress Network are connected to and collaborate
with the expert of the Mukwege Foundation crew.
• Creation of educational therapy material and capacity building through the
educational program.
• Research on trauma therapy methods.
• A stable structure is in place, supporting the target group of effected women and
their families, with the expected results, i.e. healing of individuals and communities.
• Structures and working methods will be documented.
Risk factors
Wherever money is involved, there is a risk of corruption. The choice of personnel is of great
importance when it comes to preventing corruption. The network of Dr Mukwege’s through
his long and engaging career, his collaboration with various organizations in the field, and
through his network of Yennenga Progress, Dr Mukwege and his activities are well know.
The international attention and reputation that his job has attracted to the activities
guarantee seriousness and credibility in the activites. A decent salary paid monthly is
another way to minimize the risk of corruption. Clear structures and control systems in the
daily work are a must for all human beings. Social responsibility and social networks are also
a corruption minimiser. An important method of Dr Mukwege’s, is to make sure that all
involved personnel have the same goal and the same vision. This creates strong and
dedicated teams.

14. The political situation may become worse. However, the difficult political situation is the
very reason of this project. Dr Mukwege and his crew are deeply devoted to their work, and
are already working in a very difficult situation. The unstable political situation of the DRC
which leads to extreme violence, was the very reason for Dr Mukwege to leave his
comfortable life in France to contribute with his “share” of knowledge and competence for
the development of the population. The commitment to helping the population gain a better
life in the war context is strong.
Coordination
There is a wide range of international aid organizations in the Kivu Provinces. Among only
the Swedish organizations present at the Panzi Hospital, there is close collaboration with
Läkarmissionen, PMU InterLife, and Kvinna till Kvinna. There are some common projects and
some projects taking different parts of the actions needed to support the population, such
as day care for children, nutrition, education etc.
Other organizations providing medical, legal and psychosocial assistance to survivors of
gender‐based violence are, among others, MSF, HEAL Africa, ICRC, Mercy Corps, LWF, NCA
and Dynamique des Femmes Juristes. A big number of local organizations are working in this
field, as well as so called “maisons d’écoute” providing a safe haven and counseling to
women exposed to gender based violence. Among the UN family, UNICEF, UNFPA, UNHCR
and MONUC all are concerned with work in this field of operation. The problem of rape
linked to the conflict being so widespread and touching large and inaccessible areas, the
organizations providing assistance are numerous and coordination is sometimes a problem.
In order to carry out efficient work and avoid duplication, Mukwege Foundation participates
in cluster meetings and other coordination opportunities.
Democracy and human rights in the project
Mukwege Foundation gives hope to the women affected and their families: hope of being
able to make decisions for their own lives and to build a future. This is the seed to peace.
Peace must be built on people with self‐confidence knowing they can make a change.
Dr Mukwege is a well known person both nationally and internationally. His presence in the
conflict area therefore creates a force of security, as it is known that the eyes of the world
are in the direction of what is happening around him.
By helping women to regain their self‐esteem and social status, the overall well being of the
communities is increased. Women will be able to be active actors in society and influence
future generations positively. When women are re‐integrated in their habitual context,
family support systems function well. The financial situation for the women and their
children is improved, thus avoiding malnutrition and exploitative working conditions, and
allowing parents to invest in children’s school material. By combating the stigma attached to
raped women through sensitization of various levels of society, women will be allowed to
take a more active part in decision making.

15. The Democratic Republic of Congo – Background Information About
the Social Situation
Context
The Kivu Province is deeply affected by the political problems of DRC and of Rwanda. The
UNHCR has estimated that over 857 000 people in North Kivu were displaced 2008. Rape as
a mass destruction weapon is one of the horrors the population is facing.
The war and its consequences are the most important difficulties in the project area. The
insecurity problem is vast. The choice of target group derives from the fact that Dr Mukwege
and his colleagues at the Panzi Hospital feel very strongly for their patients. Every time a
patient leaves the hospital, after healing, they fear the fact that she might soon come back
after having been raped again. As we are working against rape as a mass destruction
weapon, both conflict and HIV/AIDS are areas of great importance. It is mostly the women
being raped and infected by HIV, and they are then likely to spread it to their husbands, if
they are accepted by their husbands and if they are physically able to have sexual
intercourse after the violence they have faced.
The nationwide HIV prevalence is approximately 1.3% (source: HIV in Humanitarian
Situations). However, the war in the provinces of North and South Kivu has seriously
aggravated the situation due to the many displacements and poverty and rape as a weapon
of war. Infidelity in couples is also a contributing factor. Access to anti‐retroviral therapy is
poor, very costly and staff trained to administer it is scarce. Medical facilities are not always
easily accessible due to displacements of the population and because services are mostly
concentrated to urban centres. Voluntary testing facilities exist but are not sufficient.
The consequences on men, women, boys and girls is that they become weakened due to
recurrent diseases and find it harder to participate in work and social life. Families are
affected as family members die from AIDS. Many misconceptions exist regarding the
pandemic and persons living with HIV/AIDS are often stigmatized and excluded from social
life.
Democracy and human rights
The Congolese state fails in many of its undertakings towards its citizens. The access to
medical services, clean water, educational opportunities etc. are failing. The state is unable
to protect its population, and the corruption being widespread, decisions by legal authorities
are not guaranteed to be fair. People working for the state, such as military personnel,
teachers and other civil servants testify that their salaries are late and sometimes missing.
We face a war situation, with massive violations of human rights.
Every town has its own administrative structure. The board is composed almost entirely of
men. There is usually only a female representative for the women’s committee (one of many
sub‐committees on the board). The board members explain the low attendance of women
with that women are welcome to take up positions but “are not interested in politics” and
that they are busy doing house chores. People with low financial status are not much
respected or trusted to be representatives on the board.

16. Gender
Women and men are impacted differently by the difficulties. Women of all ages are by far
the most targeted by rape and the psychological trauma that comes with that. The men are
targeted deeply psychologically as not able to protect their wives and families. They are also
often killed if they try to stop the violence. Rape is very efficient when it comes to breaking
down the society.
The entire society is impacted as rape is a threat touching all levels of every‐day survival. The
fear of falling victim to rape creates anxiety, which affects entire families, and hinders the
population from accessing their fields and do agricultural activities, resulting in poverty.
Persons who travel by road are vulnerable as ambushes against commercial vehicles
sometimes include forcing all passengers to have sex with each other, thus targeting men as
well as women. The practice of rebels forcing family members to have intercourse impacts
men as well as women. However, women of all ages, due to their physically and culturally
weak status, are targeted in the large majority of rape cases. Rape is very efficient when it
comes to breaking down the society. Women, bearers of culture and the ones fostering and
encouraging the children, are being demoralised. The social effects on raped women are
fatal, as many are being excluded from their family unity by their husbands, who fear they
are bearers of HIV and act on social pressure to not accept that his woman has been sexually
active with another man. The excluded women often face financial difficulties, being outside
of the social support system, which affects the women as well as their children.
Resources
For persons relying on agriculture or animal farming for their subsistence, the situation has
grown almost insupportable. The fighting groups being poor and hungry, have to loot farms
in order to eat. This renders the yields of agriculture very poor. Also shop keepers are falling
victims of looting of their goods. People employed by the State such as teachers, health
staff, military etc. say that their salaries are late and sometimes not paid at all.
Opportunities (e.g. education, employment)
During the ‘80s, 60% of the children attended primary school. This number was down to 32
% in 1998, after that there are no statistics available. The situation is likely to be worse by
now. More boys than girls attend school. About 12 % of the children attend secondary
school. Not even one out of ten girls go to secondary school.
The insecure living environment has a devastating impact on children and youth. The fact
that sometimes entire areas are being emptied as the inhabitants flee and gather in urban
areas results in children not being able to pursue their education. The psychological effects
resulting from witnessing traumatic events on children and youth are also that they are
unable to concentrate and learn in school. The unemployment rate being high, many young
people feel hopelessness, are idling and abuse drugs, and are also running a high risk of
being recruited to rebel groups. Girls are vulnerable to being forced into a dependency
relationship with a boyfriend who can assist her financially.
70 % of the population lives in the countryside working with agriculture. The conflict makes
the situation even harder when it comes to official employment.