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‘They came with two guns’: the consequences of sexual violence for the mental health of women in armed conflicts

Published online by Cambridge University Press:  18 June 2010


Sexual violence has serious and multiple consequences for the mental health of women. At the psychological level, it leads to radical changes in the image that the victim has of herself, in her relations with her immediate social circle and beyond, in the community as a whole, and in the way in which the victim sees the past, present, and future. It thus has a lasting negative impact on the victim's perception of herself, of events, and of others. At the community level, it stigmatizes the victim, depriving her of any social status or intrinsic value as a person (she is seen as unfaithful or promiscuous), and thereby modifies relationships within the community with an overall deleterious effect. This article discusses these consequences of sexual violence for the mental health of women, especially those who are its victims during armed conflicts.

Copyright © International Committee of the Red Cross 2010

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1 See Evelyne Josse, ‘Déceler les violences sexuelles faites aux femmes’, 2007, and idem, ‘Accueillir et soutenir les victimes de violences sexuelles: approche orientée vers la solution’, 2007, both available at (last visited 1 March 2010).

2 For interventions by humanitarian organizations see Evelyne Josse and Vincent Dubois, Interventions humanitaires en santé mentale dans les violences de masse, De Boeck Université, Brussels, 2009; Inter-Agency Standing Committee (IASC), Guidelines for Gender-based Violence Interventions in Humanitarian Settings: Focusing on Prevention of and Response to Sexual Violence in Emergencies, IASC Taskforce on Gender in Humanitarian Assistance, Geneva, 2005, available at; International Committee of the Red Cross (ICRC), Women Facing War, ICRC, Geneva, 2001, available at; ICRC, Women and War, ICRC, Geneva, 2008, available at; Réseau des Femmes pour un Développement Associatif, Réseau des Femmes pour la Défense des Droits et la Paix, and International Alert, Le corps des Femmes Comme Champ de Bataille Durant la Guerre en République Démocratique du Congo. Violences sexuelles contre les femmes et les filles au Sud-Kivu (1996-2003), Study, 2004, available at; United Nations High Commissioner for Refugees, Sexual and Gender-based Violence against Refugees, Returnees and Internally Displaced Persons, UNHCR, Geneva, 2003; World Health Organization (WHO), Mental Health of Refugees, WHO, Geneva, 1996; ‘Sexual violence’, in E. G. Krug, et al. (eds.), World Report on Violence and Health, WHO, Geneva, 2002, available at (all last visited 19 April 2010).

3 The social contract is an agreement among individuals whereby organized society, with its hierarchical structure, is established. It consists of rules and laws that ensure social order.

4 Persons suffering from psychotic delirium lose their sense of reality, sometimes experiencing hallucinations, and are unaware of their condition.

5 This is the case in countries under sharia law (Islamic law). In some of these countries, a charge of rape can only be upheld if the perpetrator admits his crime or if the rape has been confirmed by four adult male eyewitnesses (or, in some cases, by eight female eyewitnesses). Failing this, the rape is equated with adultery and accusations made by the victim against the perpetrator are deemed slander.

6 In December 2007, King Abdullah of Saudi Arabia pardoned Touria Tiouli, a victim of gang rape. This 39-year-old woman, a French national of Moroccan origin who was working in Dubai, had been sentenced to six months in prison and 200 lashes for ‘adultery’.

7 The case of Aisha Ibrahim Duhulow, a 13-year-old girl who was raped by three men, was particularly dramatic. The al-Shabab militia, one of the armed groups that controls Somalia, convicted her of adultery in violation of sharia. As a result, she was stoned to death on 27 October 2008.

8 In the Qur'an, for instance, illicit sexual relations are defined as a criminal offence (hudud). They include sexual relations (whether consensual or not) engaged in by an unmarried person (man or woman) and those engaged in by a married person (man or woman) outside of marriage. Since rape involves sexual relations outside of marriage, it is often considered as a criminal offence and punished accordingly. This interpretation of rape is not exclusive to Islam. In sub-Saharan Africa, rape is also frequently associated with adultery, owing to the widespread belief that a man cannot force a woman to engage in sex against her will.

9 See ‘Exclusion from schools and jobs’ above.

10 I.e. avoiding thoughts, feelings, or conversations about the traumatic event.

11 I.e. symptoms leading to dissociation from society, including physical, emotional, and cognitive symptoms.

12 I.e. dissociation during or immediately after a traumatic event.

13 The purpose of the ortho-sympathetic nervous system is to raise the alarm and prepare the body for action.

14 Such fears are sometimes mistakenly called phobias. In relation to psychotraumatic syndromes, it is more accurate to refer to ‘pseudo phobias’ as they are the result of conditioning that has arisen from a real situation. This is not the case with ‘true’ phobias.

15 Avoidance behaviour is an instinctive response. It may be defined as a defence mechanism designed to increase the chances of survival in a dangerous situation.

16 Vesicovaginal or rectovaginal traumatic fistula (perforation of the membrane between the vagina and the urinary or the digestive tract), a potential physical consequence of sexual violence, causes leakage of urine and stools.

17 Resulting from trauma or from a poorly treated infection.

18 Resulting from sexual violence or from torture or beatings (deafness, blindness, partial or total paralysis, amputation, etc.).

19 These physiological changes distinguish anguish from anxiety.

20 These symptoms point to the neurovegetative stimulation of the ortho-sympathetic nervous system.

21 According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), a diagnosis of clinical depression depends on a number of specific symptoms being present for at least two weeks.

22 The neurovegetative system, also known as the autonomic nervous system, comprises the ortho-sympathetic and para-sympathetic systems.

23 Cases have been reported in the Democratic Republic of the Congo, in the provinces of Ituri and North and South Kivu.

24 Cognitive science is the study of mental processes, i.e. knowledge, learning, thought reasoning, consciousness, imagination, memory, language, etc.

25 ‘Traumatic amnesia’ is the inability to remember certain aspects of a traumatic event, while ‘traumatic hypermnesia’ is unusual clarity of memory regarding a particular aspect of a traumatic event, generally a sensorial one.

26 An adaptation strategy consists of a cognitive change (change in thought pattern) or a behavioural adjustment (action) made by a person in order to cope with an ‘imbalance between demands and resources’, whether internal or external. See Richard S. Lazarus and Susan Folkman, Stress, Appraisal, and Coping, Springer, New York, 1984.