Source: Human Rights Watch
Members of Burundi ruling party’s youth league, the Imbonerakure, have repeatedly gang-raped women since a wave of political protests began in 2015. Many of the rapes appear to have been aimed at family members of perceived government opponents. Policemen or men wearing police uniforms have also committed rape.

In a pattern of abuse in many locations and in several provinces, men armed with guns, sticks, or knives have raped women during attacks on their homes, most often at night. Male family members, some of them members of opposition parties, were also targeted and some killed or abducted. Survivors reported both immediate injuries and longer-term consequences, including sexually transmitted infections, unwanted pregnancies, anxiety, and depression. Women have not been safe from rape in refugee camps, and services to assist them are inadequate and need to be better funded. Tanzanian police working in the camp should ensure they fully investigate all rape cases.

“Attackers from Burundi’s ruling party youth league tied up, brutally beat, and gang-raped women, often with their children nearby,” said Skye Wheeler, women’s rights emergencies researcher at Human Rights Watch. “Many of the women have suffered long-term physical and psychological consequences.”

Human Rights Watch interviewed more than 70 rape victims in May 2016, in the Nduta refugee camp in western Tanzania. Nduta is one of three Tanzanian camps sheltering 140,000 Burundian refugees.

Dozens of women said they were raped in or close to their homes. Fourteen said they recognized at least one of the attackers as an Imbonerakure. In some other cases, they said the rapists wore police uniforms. In other cases, they could not determine who the attackers were.

A 36-year-old woman said she was raped in the Mutakura neighborhood of Bujumbura, the capital, in October 2015: “I was held by the arms and legs. [An attacker] said: ‘Let’s kill her, she is an [opposition National Liberation Forces] FNL wife’ as they raped me.”

Three Imbonerakure raped her, she said, one of whom she said she recognized from his patrols in the neighborhood. Imbonerakure had verbally harassed her husband, an FNL member, during visits to their home on several occasions before the attack during which the men took him away. His body was found in a nearby ditch the following day. Like many others Human Rights Watch interviewed, the victim said she still has trouble sleeping and has flashbacks of the attack.

In some cases, rape appeared to be used to try to deter people from fleeing Burundi. Six women said they were raped on the Burundian side of the Tanzanian border by people they believed to be Imbonerakure or knew to be Burundian police, between mid-2015 and early 2016. The attackers ordered the victims to return home, or verbally harassed them for attempting to leave. Sixteen others who tried to leave reported extortion, beatings, verbal harassment, or detention by Imbonerakure or police. Other rapes may have been opportunistic.

Human Rights Watch wrote to the president of the ruling party, Pascal Nyabenda, on July 12, 2016, seeking his response to allegations of rape by Imbonerakure, but did not receive a reply.

Many women fled Burundi immediately after they were raped, before they were able to get emergency medical services. Human Rights Watch found that in many cases women were not identified as rape victims when they arrived at humanitarian transit camps on the Tanzanian side of the border and so did not get emergency care for HIV exposure or emergency contraception, which are among World Health Organization minimum standards for post-rape care.

One woman who did not receive such emergency care became pregnant from the rape. Another found out later she was HIV positive. Both said there was no obvious way to report the rapes at the transit camps. Humanitarians told Human Rights Watch that they were continuing to train staff at the border points, had stockpiled drugs at the border, and were trying to increase the number of female staff there, to encourage women to report sexual violence.

People who fled to Tanzania are not safe from sexual violence in refugee camps, where the numbers of rapes are alarmingly high, including of children. Women and girls have been raped both inside the camps and in areas outside where they collect firewood or goods for market, often as many as three or four cases a week. Women said the attackers included both other Burundian refugees and Tanzanians. Humanitarians told Human Rights Watch they are concerned about high numbers of rapes of children.

Victims said that aid groups providing services in the camps do not provide adequate psychological services and trauma care. The Office of the United Nations High Commissioner for Refugees (UNHCR) reported that donor countries have provided less than 40 percent of funds requested in aid to Burundi refugees in Tanzania.

From May through September 2015, 323 (264 women and 59 girls) reported cases of rape or sexual assault that occurred in Burundi, including as they were trying to flee, to humanitarians in Nyaragusu, the first and biggest refugee Tanzanian camp hosting Burundians, according to UNHCR. UNHCR said that of all incidents reported from June to October 2015, according to the women, 16 were allegedly perpetrated by the police and 177 were allegedly perpetrated by other members of the security forces or Imbonerakure.

Over 170 people have reported rapes in Burundi or during their flight to humanitarians in the two newest Tanzanian camps, Nduta and Mtendeli, since they opened late last year, according to UNHCR. It is possible that some women may have reported rapes twice if they moved from Nyaragusu to the newer camps. Reported rape cases may only represent a percentage of the total. Medical staff of aid organizations told Human Rights Watch they believe many women do not report rape unless they seek treatment for continuing medical problems.

Some women interviewed described tense relations between Tutsis and Hutus in the camp and often between or within families. Some said they feared possible attacks from Imbonerakure whom they claimed were in Nduta to target and harass people. Human Rights Watch did not verify these claims.

UNHCR funds Tanzanian police in the refugee camps. The police station in Nduta camp is staffed by least three female police who work at a “gender desk” that encourages women to report abuse. Several interviewees said they appreciated efforts by Tanzanian police, including detaining alleged perpetrators, although sometimes only for short periods.

In other cases, however, women said the Tanzanian police did not seem interested in finding those responsible if the women had been attacked outside Nduta camp, or had not seriously tried to arrest attackers in the camp. A legal assistance organization, the Women’s Legal Aid Center (WILAC), which works in Nduta, said that five people have been officially charged with rape since Nduta opened in October. Four were found not guilty, and one case was ongoing in late May. There have been two convictions for domestic violence.

Abortion services are only legally available in Tanzania to save a woman’s life. This highly restrictive law means that women pregnant as a result of rape are forced to have the children. Medical service providers should use the ban’s exception to the greatest extent possible and should consider whether a woman choosing a dangerous illegal abortion or committing suicide as a result presents a risk to life. The Tanzanian government should change its laws to make abortion available to all women, or at a minimum, to rape victims.

In 2015 and 2016, Human Rights Watch documented how the Burundian police and intelligence services, along with Imbonerakure, targeted perceived opponents with killings, disappearances, torture, and arbitrary arrests. President Pierre Nkurunziza should publicly denounce security force and Imbonerakure abuses and ensure that rapists and other abusers are held to account.

The UN Security Council should authorize a strong international police force for Burundi, including women officers, to deter abuses, including rape. The UN and countries that provide police should ensure that they have training and expertise in investigating these crimes, and that providing security and support to survivors of sexual violence is among their priorities.

The UN Security Council should urgently set up an independent, international commission of inquiry with judicial, forensic, and medical expertise, as well as expertise in investigating torture and sexual violence. The commission should produce a timely public report that includes recommendations on accountability, possible financial reparations for victims, and improved access to health services. The commission would build on the work of the Office of the High Commissioner of Human Rights and other UN and African Union initiatives in Burundi, and could contribute to the International Criminal Court’s preliminary examination of the situation in Burundi.

Identification of victims of sexual violence at Tanzanian transit camps should be improved, including by increasing female staff and ensuring victims have a safe and confidential place to report rape. Rape victims should have access to post-rape care that meets World Health Organization standards, including, if needed, emergency HIV prophylaxis and contraception.

“More and more people globally are living in displacement, or as refugees, for increasingly long periods,” Wheeler said. “In Tanzania, as elsewhere, aid groups, host governments, and wealthier donor countries need to ramp up services provision to meet their obligations to protect the health and safety of rape victims and to ensure that their most basic rights are met.”

Crisis in Burundi
In April 2015, President Pierre Nkurunziza of Burundi announced that he would run for a third term, setting off a political and human rights crisis. Police violently repressed demonstrations and the government cracked down on perceived opponents and critics. Targeted killings and attacks by government forces and armed opposition groups escalated. By December, several hundred people had been killed. Serious abuses in Burundi, including torture and enforced disappearances, have continued throughout the first half of 2016.

Hundreds of thousands of Burundians fled to surrounding countries, most to Tanzania, where three refugee camps were set up, but also to Uganda, Rwanda, and the Democratic Republic of Congo. Human Rights Watch has not conducted research into rape of Burundian refugees in these other countries.

Rape by Imbonerakure
Burundi has a long history of rape, including during periods of conflict or political crisis. There are indications there may be high rates of this crime even in times of relative stability. In June 2015, for example, Centre Seruka, a Burundian organization that helps victims of sexual violence, said that between 120 and 130 victims of sexual violence sought help at their facilities each month. The majority were children.

The survivors interviewed said that in some cases, they had been raped by men they knew to be Imbonerakure, who sometimes worked with the police. Many could not identify their rapist by name, but believed they were raped because of a family member’s link to an opposition party or a grievance against their husband. The Imbonerakure, who are the members of the youth league of the ruling party, the Council for the Defense of Democracy – Forces for the Defense of Democracy (CNDD-FDD), are organized across Burundi, down to the local level, and have long been used to target government opponents. Their role in the repression has increased since April 2015.

More than 10 women interviewed said that local Imbonerakure had harassed them even before April 2015, although this worsened after Nzurunziza’s announcement that he would run again. Several women said that Imbonerakure had started carrying weapons and had taken on a more prominent security role in their villages or towns.

Imbonerakure known to victims, men in police uniforms, and unidentified armed men, some of whom accused the victims of supporting an opposition party or being married to an opposition supporter, were among those responsible for rapes or gang-rapes of 38 women interviewed by Human Rights Watch. In two cases, girls were gang-raped during attacks in or near their homes. The attacks, almost always at night, were by a group of men with guns, sticks, grenades, or knives. In the majority of cases, more than one man raped the victim.

In 23 cases, the victims did not recognize the people who attacked them, but said some of the men were dressed in ruling party T-shirts or police uniforms, which Imbonerakure sometimes wear. The victims said that Imbonerakure either had previously threatened family members, or that the attackers had attacked or asked for male relatives and made derogatory comments about their political beliefs.

Some women also said they believed their attackers were Imbonerakure because the group controlled the victims’ neighborhoods and there were no other armed groups in their area. In one case, the attackers took a mobile phone, and in two other cases, they extorted money from the women, but robbery did not appear to be their main motivation.

In several attacks the women described, the attackers either killed a male family member or took him away. In three cases, the attackers beat a husband or other male relative. In four cases, the male relative fled at the beginning of the attack.

A group of Imbonerakure raped O.P.’s 8-year-old daughter after they attacked her family home, in Karusi province, in late April 2015. O.P. saw a local Imbonerakure leader enter the house with other men before she ran away, leaving her daughter behind. She returned to find her daughter sitting in bloody sheets. O.P.’s daughter told her that four men had raped her. O.P.’s husband left the country the following day because he feared the attack was directed at him. He had already been arrested twice and detained for short periods by local Imbonerakure for not joining the ruling party, O.P. said.

Several rapes reported to Human Rights Watch took place at the end of 2015, when human rights abuses escalated in Burundi, especially in Bujumbura.

N.B.’s husband, a policeman and member of the FNL, was shot dead while on duty. On December 13, 2015, N.B., 22, said, a group of Imbonerakure forced their way into her home, beat her with sticks, and two of them raped her. She said that men, who had told her they were Imbonerakure, had repeatedly forced their way into her home in the three months prior to the attack looking for her husband, verbally harassing her and accusing her of hiding him. In five cases, the women interviewed said the dead bodies of men who were abducted were found dumped near the site of the attack.

Others did not know the whereabouts of family members for many weeks. Seventeen-year-old S.W. did not know where her father was for months after her family was attacked in August 2015, in Bujumbura’s Kinama neighborhood. Four Imbonerakure, dressed in ruling party T-shirts, dragged her to a banana grove near her house and raped her after other men in their group took away her father, a member of the opposition Movement for Solidarity and Democracy (MSD). A neighbor who was an Imbonerakure eventually told the family her father had been killed.

Women said that if the man wanted by the attackers was not there, they would demand to know his whereabouts and would sometimes tell the victim that they were raping her because they could not find the man. In nine cases, women said the men had fled before the rape took place, or had begun habitually sleeping elsewhere because of threats.

M.N.’s husband, she said, had been harassed for his membership in an opposition party since his family returned to Muyinga province in Burundi in 2012, from exile in Tanzania, and had begun sleeping in friends’ houses for safety. In December 2015, a group of Imbonerakure told her neighbors to stay indoors and forced their way into her house. Two of them picked M.N. up from her bed, threw her on the ground, and raped her, she said. She recognized one of them as an Imbonerakure.

In three other cases, the rape took place weeks or months after a husband or other male relative had been killed or disappeared in an earlier attack.

In many cases, known Imbonerakure had threatened or attacked the targeted male member before the attack, often during daytime house visits. Women often continued to receive threats after a male relative was attacked and sometimes after the woman had been raped.

Eleven of the reported cases of rapes and other abuses took place in Bujumbura, mostly in Mutakura, Cibitoke, and Musaga neighborhoods, where police had clashed with protesters over President Nkurunziza’s bid for a third term. However, similar attacks were reported in other locations. Many women in the refugee camps were from border areas such as Makamba, Ruyigi, and Muyinga provinces.

In some cases, the attackers’ comments during the attacks, as well as harassment before and afterward, would appear to indicate that the leading motivation behind the abuses was political, connected to the victim’s relatives being members of opposition parties. However, there may have been other motivations. Many of the women who had been attacked had returned to Burundi between 2010 and 2012, after living in Tanzania for many years. Many found themselves embroiled in land conflicts when they returned, with neighbors or other family members occupying their homes. In several cases, women said that the attacks by Imbonerakure appeared to be connected to long-standing disputes over land in their communities.

Some women believed ethnicity may have been a factor. Two Tutsi women said the attackers made ethnic slurs during the attack. Others believed the ethnic dimension was a more prominent factor in communities with few Tutsi families. Human Rights Watch did not ask interviewees for their ethnicity.

Some attacks may also have been linked to personal disputes or grievances. In July 2015, two men raped 33-year-old J.N. in Muyinga province, she said, while three Imbonerakure watched, including a local leader whose face she recognized. The men beat her husband and then took him from the house during the attack. She said that she believes she was raped because she and her husband were FNL members, but also because her husband, a local neighborhood leader, reported carousing at a prostitute’s house by some local men to the police and some of the men were arrested. J.N. reported that the men who attacked her said, “he stopped us from using their prostitute, so we’re [having sex with] you instead.”

Rape by Security Forces
In several cases, groups of men who attacked homes included one or more men in police or army uniforms. These may have been members of security forces or Imbonerakure, who often dress in police or military uniform. Members of the police or army have also attacked and raped women. Human Rights Watch documented several cases in which police raped women.

A group of policemen, all in blue police uniform, visited and harassed 28-year-old F.P., she said, at her house in the town of Nyanza Lac three times – in April, July, and September 2015, when two of them raped her. In April, the policemen took some of her belongings and in July, they stole bank account documents that had belonged to her husband, who had been a soldier and peacekeeper in Somalia before he died there in 2014. Local Imbonerakure also harassed her frequently, saying her husband had only managed to get rich by bribing his way into peacekeeping posts.

Two women said they were raped in police detention. A 26-year-old local leader of an opposition party was detained for a night in a police station in late February 2016, after she was accused of holding political meetings and refusing to join the CNDD-FDD. A senior policeman working in the detention center raped her, she said.

Few women feel safe reporting rapes or other abuses to the police, especially in view of the close relationship between some Imbonerakure and the police. Many of those interviewed said they feared they would have been killed had they done so. Fear of further attacks as well as the desire to leave the country quickly also prevented women from seeking emergency health care in Burundi, including emergency contraception and post-exposure prophylaxis to prevent HIV infections.

Four soldiers took 27-year-old M.D. from her house in Kamenge, in Bujumbura, after they failed to find her husband, a MSD member who had been detained several times, in mid-December 2015. They held her for a day in the barracks in Kamenge, where two of the soldiers raped and beat her.

Rape, Harassment During Flight
Women have been raped on both sides of the border as they fled to Tanzania, part of a broader pattern of harassment and extortion of people trying to leave Burundi.

Some of the rapes on the Burundi side appeared to be attempts by members of the security forces and Imbonerakure to prevent people from leaving Burundi. Burundian police raped H.S., 24, in mid-May 2015, when she tried to cross at an official border point in Kabonga, Makamba province. She said the men called her a dog and told her she was crazy to try to leave the country when there was no war. They beat her and dragged her to some bushes, where two of the men raped her before a group of soldiers intervened.

In another case, three men in police uniform raped R.N. in October 2015, in Makamba province on a path through the bush as she was about to reach the Muragarazi river on the border.

In other cases, women said that they were raped by unknown men. A group of men in the Murama village area of Muyinga province stopped a group of women trying to cross the border in August 2015, and demanded to know why they were trying to leave the country. Three of the men tied up B.K., 45, and her adult daughter and raped them. The men let them go, she said, after they promised not to tell anyone. Twenty-seven-year-old G.O. said two of a group of men in CNDD-FDD T-shirts raped her at night in the Gatwe area of Makamba province in late October 2015.

In some cases, rapes appear to have been opportunistic. Four women reported that they were raped on the Tanzanian side of the border by unknown men who spoke Kiha, a language local to the Kigoma area of Tanzania, or Kiswahili.

Lack of Services in Tanzania Transit Camps
The border between Burundi and Tanzania is porous, with numerous crossings. Aid organizations have established a number of transit points and transit centers in Tanzania where refugees can register and receive food and shelter before being taken to refugee camps.

Human Rights Watch found that in the majority of cases, women interviewed who had been raped a few days before reaching transit camps were not identified as victims by staff there. Women said that they sometimes felt too shy to say they had been raped, especially if only male staff were present. Others said that the staff seemed too busy or that they did not report the rape because they were not asked.

As a result, unless women were quickly transported to a refugee camp, they missed an opportunity to access emergency HIV post-exposure prophylaxis, which must be taken within 72 hours of exposure, or emergency contraception, which should be administered within 120 hours. Of 20 victims interviewed who arrived at transit camps within the five-day window, aid workers identified only two as rape victims and referred them for urgent assistance. Five were lucky enough to get on a bus quickly to a camp, but 13 missed the window altogether, with some of them left in the transit camps for more than a week.

One became pregnant after a rape that took place less than 24 hours before she arrived at a transit center. Another who had been raped for the second time since 2015, while crossing the border, was not identified as a rape victim at a transit camp. She, like two other interviewees, later found out she was HIV positive. She did not know whether she contracted the virus during the first or second rape.

Aid workers have made efforts to put in place a system to identify rape victims at border crossings and to help them get care. It is not clear why the procedures are not always working. UNHCR told Human Rights Watch in a letter that aid workers at border points have been trained to screen new arrivals to try to find out if they have experienced sexual violence and if so, expedite their referral for emergency health care. The also said that border point staff coordinate with aid workers in the camps to help ensure victims receive care in the camps. UNHCR also said that in May and June 2016, they supplied staff of nongovernmental groups at border entry points with emergency HIV and contraceptive care.

The International Rescue Committee, which provides services at 10 border crossings, said in a letter that they had made specific efforts to increase their numbers of female staff in accordance with best practices so that female victims of rape feel more comfortable reporting it. However, the group said that because of security concerns in these isolated places, they struggled to retain female staff. It appears from the interviews that women found fewer barriers to reporting rape at Nduta than at border points.

While the primary responsibility to provide services rests with the government, in countries where the government is unwilling or unable to meet these needs and where UN agencies are operating, these agencies have a clear human rights obligation to ensure that urgent needs are met to fulfil basic rights to health and life.

Rape in Nduta Camp
There have been many reports of rape in both Nduta and the older Nyaragusu refugee camp, further south, in the Kigoma area of Tanzania. Women, men, and children have been raped both inside and outside the camps. Tanzanian camp authorities and UNHCR have taken important steps to prevent rape but should do more to ensure protection, including through enforcing greater accountability for attackers. To fully meet their obligations, humanitarians will need to be better funded.

Human Rights Watch was especially concerned to find that large numbers of children have been raped in Nduta. Human Rights Watch interviewed three girls under 18 and the close relatives of five other children, all under 12, including three under 5, who had been raped since the camp opened in October 2015.

Eight women or girls interviewed had been raped outside the camp, while collecting firewood or buying produce to sell in Nduta market. No one was arrested and the attackers have not been identified. Two 11-year-old girls were raped in the same incident in February 2016, by men they believed were Tanzanian who chased a group of children collecting firewood behind the police station, about a 10-minute walk from the camp. No one has been arrested, and a parent of one of the girls said that the police did not go to the nearby village to investigate.

Rape of women outside of refugee camps occurs in many displacement sites in the region. However, in Nduta, this appears to be only part of the problem. Human Rights Watch interviewed more women and girls who had been raped inside than outside the camp.

In April 2016, two young men raped 15-year-old F.N. in a tent in the camp. F.N. said that as a result, she has chronic hip and back pain and suffered trauma and depression. Her mother said she was afraid to report the case or seek justice, even though they know one of the rapists because she fears retribution from his family.

Similar fears led the parents of 4-year-old S.A. not to report the rape of their daughter by a 16-year-old boy, although in this case her parents were also concerned that the police would beat the boy, or his father. A 14-year-old boy raped another 4-year-old, D.C., who lived in a nearby tent, in early May 2016. The mother decided not to press charges as the father would likely be jailed in his son’s place, which she thought would be unfair.

The Need for Greater Protection, Counseling Services in Nduta
The Nduta police have not always made serious efforts to arrest rapists. For example, a church leader raped 27-year-old H.N. in January 2016, after he entered her tent to, he said, pray for her. H.N. told the police but the man has not been arrested. Camp zone leaders who work in close cooperation with the police told her that her rapist appeared to have magical powers of disappearance when they tried to find him. The man also threatened her after the rape. S.K., 15, made several trips to the police to report her rape in January 2016, and told the police where the rapist lived, but as of May he had still not been arrested.

The Tanzanian police, including those based in and around Nduta, should thoroughly investigate rapes both outside and inside the camp. They should actively encourage women to report rapes and work with women’s groups to investigate, even if the victim cannot identify the attacker.

Human Rights Watch wrote a letter to the Tanzanian Ministry of Home Affairs on July 1, 2016, but did not receive a reply.

Tanzania has historically provided tens of thousands of refugees’ legal residency, including 162,000 people between 2008 and 2010, and has allowed hundreds of thousands more to enter and stay in camps in Tanzania. However, Tanzanian authorities made tens of thousands of other refugees return to Burundi in 2011 and 2012. Tanzania’s current encampment policy restricts refugees’ movements to four miles from the camp. Because authorities sometimes punish refugees who break this rule, women raped further afield are afraid to report rapes.

More concerted efforts by the Tanzanian police to identify, investigate, and prosecute alleged perpetrators could help reduce rape in Nduta. Aid groups should also continue to support survivors with medical, including psychosocial, and legal services and monitor to protect victims and their families from revenge attacks. UNHCR and IRC should continue training for police as well as community meetings and advocacy by leaders to encourage reporting. UNHCR has provided the camp police with vehicles and motorbikes so they can patrol inside and outside the camp.

Together with the Tanzanian government, UNHCR oversees protection activities in all the refugee camps. However, Human Rights Watch found that victims were often unable to access UNHCR staff or had to wait for long periods for an appointment. In four cases, women said they had repeatedly visited the Nduta UNHCR office to request an appointment, but had been unable to make an appointment or told to go away. One was looking for assistance after her 4-year-old child had been raped in the camp. Another woman, who visited the UNHCR office in April 2016, said she had been given an appointment in June. UNHCR told Human Rights Watch in its letter that it is improving its protection counseling services and hope to expand them further, but that staffing shortages mean that such services are more limited in Nduta than, for example, in Nyaragusu.

Officials responsible for running the camp should continue to carry out concrete measures to reduce attacks on women, such as improving lighting in the camp and ensuring all latrines can be locked. Several women said that they urinated in plastic bottles cut in half to avoid using unlit latrines at night. Some had received solar lamps, but several had been stolen. Many women said that their personal belongings had been stolen from their tents, including medical documentation of rapes which would be important in efforts to seek justice.

UNHCR is working with Tanzania’s Home Affairs Ministry on a pilot project to produce bio-mass briquettes as an alternative to firewood. The use of improved mud-stoves has been promoted in the camps. UNHCR told Human Rights Watch that group firewood collection times have also been established and daily security messages are shared in the camp through community outreach teams. IRC conducts weekly community campaigns to raise awareness about the dangers and how women and girls can minimize risk.

Some special efforts have been made by aid groups to protect children from rape, including establishing child protection groups, drop-off child care centers, and campaigns to raise awareness about the dangers of leaving children unattended.

Five women said they had seen the Imbonerakure who allegedly raped them, or other Imbonerakure, in the refugee camp. Two said the men had threatened them. Several Tutsi women also said that they felt unsafe because of their ethnicity and that other refugees harassed and insulted them. One woman said men had called her a “cockroach” – a term used to insult Tutsi during the 1994 Rwandan genocide – and told her she should have fled to Rwanda instead. The woman reported the case to the police, who intervened. The men apologized and promised they would not insult her again.

It is not clear how UNHCR plans on tackling threats to security in the camp, but increasing efforts are being made, the agency said, to support efforts by refugees to improve their security. A more grassroots approach to prevention and response to rape could be effective, such as a community-led effort in the 1990s that used refugee “crisis intervention teams,” who identified rape victims, helped them access services, and worked within their communities to address risks.

IRC is engaging religious leaders and others to promote nonviolence and has initiated a large program with some 400 women and men to examine and change attitudes and practices.

The long term consequences of rape are often devastating. Only two women out of more than 70 interviewed said that they felt largely unchanged emotionally or physically since the rapes. The others described experiencing chronic problems they said were a result of the rape, including poor physical health, infections, and continuing problems with HIV and other sexually transmitted diseases. Women with HIV said that they were struggling to find enough nutritious food to stay healthy, and two said they were not able to maintain a regime of HIV prophylaxis medications because they could not get enough to eat.

A large proportion of the women said that they still felt pain in their hips, back or stomach and several women said they were struggling to carry water or perform other activities. They reported persistent problems with sleeping, waking up suddenly screaming in the night, and nightmares. Emotional pain, a feeling of disconnection from others including their children, self-disgust, and shame were common. Two women said that they feared that the rape has made them worse mothers. Women also reported constantly thinking about the rapes, experiencing reoccurring flashbacks of the rape or killings, depression, or feeling no peace or happiness. There was a widespread – and in Human Rights Watch’s view, an accurate – perception that not enough was being done to assist to rape victims, although many women did not know that psychosocial – mental health – care should be key parts of government or aid agency responses to rape and are included in all global standards.

Human Rights Watch spoke to five women who had become pregnant or had had children as a result of rape. In all cases, the pregnancy had brought discord. Women reported ambiguous feelings for the children and family problems. In some cases, the women’s husband had refused to accept the pregnancy or the child. In other cases, the husband had forbidden the woman to get an abortion. In two cases, women said aid staff told them they had a religious and moral duty to keep the child. In all cases, the women were not able to choose what is best for them and their families after suffering a gross human rights abuse, not least because of Tanzania’s highly restrictive abortion laws.

More services from aid agencies or the government are needed to provide ongoing case management for victims, especially psychosocial and psychological support. Women interviewed were grateful for counseling, legal, and other support from IRC, but they said it this tended to be short-term and inadequate.

A handful of women interviewed had been invited to join an IRC women’s basket weaving group, which they described as helpful. A large number said that they would love to participate in group activities. UNHCR and IRC told Human Rights Watch that group counseling sessions were initiated in May and that three groups are now meeting. This may help meet a great hunger for healing.

About half the women interviewed had one or two counseling sessions at the IRC center in the camp. Some women said they benefitted from confidential dialogue and would have liked more sessions but were not given further appointments. Instead, women were told they could return if they had problems – confusing for victims experiencing depression, chronic shame, or low self-esteem. Although some women received further counseling, this was generally not the case even for children or survivors who became pregnant from rape, contracted HIV, or faced domestic discord or abuse because of the rapes.

A lack of funding has restricted IRC’s capacity to assist. IRC told Human Rights Watch that they have faced up to 90 new reported cases per month, in part because its outreach to tell women about their services and encourage women to report rapes had created a great demand for the services of the three people providing care. Some emergency cases are especially time-consuming. IRC is continuing apply for more funds to increase services and has improved its system for prioritizing cases and hired refugees to provide support in less complicated cases.

Many women took advantage of other services provided by IRC, including accompaniment to the hospital and to police to report crimes and said these were extremely useful.

All the parents of the child survivors said their children were still affected by the rape, exhibiting withdrawal or moodiness. IRC has a child counseling room and in two cases had provided child survivors with long-term counseling support and space in their shelter. UNHCR said that targeted and comprehensive training on working with child survivors has been planned for IRC staff who already have general training, as has equipping IRC’s child care room for play therapy. Aid organizations should ensure services are equally available to male victims.

Three of the women interviewed, including two children, had stayed in a small IRC shelter in the camp. But it only had space for five women at a time, and they are only meant to stay for a few days. Improving this service could present an important option for women facing domestic violence or other abuse in the camp.

• Burundi