Fistula and other adverse reproductive health outcomes among women victims of conflict-related sexual violence: a population-based cross-sectional study.

BACKGROUND: Sexual violence (SV) is being used widely as a weapon of war. However, few studies have investigated its health effects. The objective of the present study is to investigate the relationship between sexual violence and several serious reproductive health conditions including fistula. METHODS: We conducted a cross-sectional study among 320 women living in Goma, the Democratic Republic of Congo. We assessed the association of four outcomes: fistula, chronic pelvic pain, desire for sex, and desire for children, with SV in two contexts: conflict-related and nonconflict-related. Two groups of women: those who experienced conflict-related sexual violence (CRSV) and those who experienced nonconflict-related sexual violence (NCRSV), were compared with women who had not experienced SV. Data were collected by trained interviewers using a standard questionnaire. RESULTS: Compared with women who did not experience SV, after adjustment for potential confounders, women who experienced CRSV were significantly more likely to have fistula (OR = 11.1, 95% CI [3.1-39.3]), chronic pelvic pain (OR = 5.1, 95% CI [2.4-10.9]), and absence of desire for sex (OR = 3.5, 95% CI [1.7-6.9]) and children (OR = 3.5, 95% CI [1.6-7.8]). Women who experienced NCRSV were more likely to report absence of desire for children (OR = 2.7, 95% CI [1.1-6.5]), and seemed more likely to report chronic pelvic pain (OR = 2.3, 95% CI [0.95-5.8]), although the difference was not statistically significant. Women who experienced NCRSV did not have higher odds for fistula and absence of sexual desire. CONCLUSION: Conflict-related sexual violence can contribute to women's adverse reproductive health outcomes. Its impact is more devastating than that of NCRSV.

Jaw injuries of independence victims from the 1991 War in Croatia.

In the aetiology of maxillofacial injuries, car accidents, violence, sports injuries and lately war injuries are frequently mentioned. The purpose of this study was to exhibit and analyse types of jaw injuries on bodies exhumed from massive and individual graves located in regions temporarily occupied during the War in Croatia that lasted from 1991 to 1995. The sample was the post-mortal documentation of the orofacial region (set of teeth, photographs, radiographic images) of 1068 victims exhumed from massive grave sites in Croatia. The jaw traumatism was analysed on the whole sample as well as on individual graves, whilst the analysis of trauma frequency was performed separately. Descriptive statistics were computed and the value of P < .05 was accepted as statistically significant. Results of this study showed that out of 1068 examined corpses, 332 had midface and lower face fractures, which was 31.1% of the total number. Lower face fractures were more frequent with 28.1%. Age related frequency analysis showed a significant dependency. There were 34.6% of fractures in the under 30 age group, 34.2% in those aged 30-60, while 21.3% of fractures were noted in the over 60 age group. Female bodies had the lowest number of jaw fractures regardless of the osteoporotic changes. The results of this study suggest that younger and middle aged persons were molested more. Jaw fractures suggest ante-mortal molestation. In females, the more likely fracture causes were the falls of the bodies into the graves or body to body hits.

Croatian war veterans in print media in 1996 and in 2006.

INTRODUCTION: The media have an important role in maintaining and creating social relations and social environment. This especially refers to the war and post-war period in which the media can form a part of the prevention context, i.e., the media can facilitate the process of recovery from war trauma, but they can also contribute to stigmatization and retraumatization. Our aim was to analyze Croatian newspaper reports about Croatian war veterans and to determine the differences in ways of dealing with the subject during 1996 and 2006. METHODS: The data were gathered by reviewing two daily papers, Novi list and Ve?ernji list and Globus weekly. The analysis included newspaper reports related to the subject of Croatian war veterans, published in the first six months of 1996 and 2006. Quantitative and qualitative methods were used to analyze both the form and the content of the reports. RESULTS: A total of 538 newspaper reports were published in the above-stated periods. In the first half of 2006 the number of reports related to the subject of Croatian war veterans dropped 6.5 percent compared to the first half of 1996. Topics prevalent at the end of the war were different from those ten years later. The 1996 articles mostly reported on activities organized by various associations, medal-awarding ceremonies, military operations etc. Ten years later the topics focused on war crimes, trials of Croatian war generals and dissatisfaction with veterans' rights and legislation. Moreover, articles relating to crime and reports about suicides and attempts of suicide increased significantly in 2006. CONCLUSION: During the ten-year period, the media image of Croatian war veterans significantly changed, which was expected owing to different social circumstances immediately after the war and ten years later. The prevalence of topics negative in tone and a lack of proactive stories reflect, but also create, a social context which can affect the process of recovery from traumatization.

[Process of exhumation and identification of victims of the 1992-1995 war in the territory of Bosnia and Herzegovina]. / Proces ekshumacji i identyfikacji ofiar wojny na terenie Bosni i Hercegowiny w latach 1992-1995.

Three and half years of war in Bosnia-Herzegovina in 1992-1995 took lives of thousands of people. About 30,000 of them were accounted for and reported as missing. Fighting and ethnic cleansing took place throughout the country. In consequence bodies of killed persons were buried in endless number of clandestine mass graves, dumped into rivers, wells, septic tanks and caves, or simply left unburied in fields, meadows and forests. Therefore, it is essential to obtain information about the potential grave or graves, which allows their proper location. More than 20,000 victims were exhumed to the end of 2008. Unfortunately, majority of remains recovered from secondary graves represents either incomplete skeletons, not associated bones or bone fragments. In this situation, only a large-scale DNA testing, in the future, will answer for question how many people are victims of that war. It is predicted that process of exhumation and identification will be finished until 2015 year.

Gender differences in war-related disappearance in Croatia (1991-1995).

From 1991-1995, the war in Croatia cost tens of thousands of lives (approximately 11834 persons killed between 1991-1994), and human rights abuses led to significant numbers of disappeared persons (3052). A total of 2395 families were searching for one disappeared person and 168 families of disappeared were searching for more than one person. 2035 men were reported disappeared and 528 women. However, while the majority or 60% (1226) of the men were between the ages of 18-49, 83% (438) of the women were between the ages of 50-96. Though the majority of missing persons of both genders were civilians, the disappeared women were more likely to be civilians (99%) than the disappeared men (52%), though only 23% of the men were regular army military personnel. The majority (55%) of men were previously engaged in paid employment, while 81% of women were farm or housewives, or pensioners. Most men (53%) were reported by informants to have disappeared outside of their home, while the majority (75%) of women disappeared from their home. Among those searching for the disappeared, 27% of those searching for men believed the person was alive or might still be alive, in contrast, only 18% of those searching for women believed them still alive. An important gender difference occurred in the pattern of disappearance in Croatia; most disappeared men were of combatant age, employed, and similar to the general population in key demographic characteristics, while most disappeared women were rural, less educated, and elderly.

Exposure to war crimes and implications for peace building in northern Uganda.

CONTEXT: Since the late 1980s, the Lord's Resistance Army has waged war against the Ugandan People's Democratic Army and the people of northern Uganda. Ending the conflict and achieving peace have proven to be challenges. In this context, it is important to examine population-based data on exposure to war crimes to understand how survivors perceive mechanisms aimed at achieving a lasting peace. OBJECTIVES: To assess the level of exposure to war-related violence and the prevalence of posttraumatic stress disorder (PTSD) and depression symptoms in northern Uganda and to determine how these variables are associated with respondents' views about peace. DESIGN, SETTING, AND PARTICIPANTS: Multistage, stratified, random cluster survey of 2585 adults aged 18 years or older conducted in villages and camps for internally displaced persons in 4 districts of northern Uganda in April and May 2005. MAIN OUTCOME MEASURES: Rates and patterns of exposure to trauma; symptom criteria for PTSD, assessed via the PTSD Checklist-Civilian Version with a total severity score of 44; symptoms of depression, assessed via the Johns Hopkins Depression Symptom Checklist with a cutoff of 42; and opinions and attitudes about peace. RESULTS: Among the respondents, 1774 of 2389 (74.3%) met PTSD symptom criteria and 1151 of 2585 (44.5%) met depression symptom criteria. Four patterns of exposure to trauma were distinguished: those with low exposure (group 1; 21.4%), witnesses to war-related violence (group 2; 17.8%), those threatened with death and/or physically injured (group 3; 16.4%), and those abducted (group 4; 44.3%). Respondents in groups 3 and 4, who experienced the most traumatic exposures, were more likely to have PTSD symptoms compared with group 1 (group 3 vs group 1: odds ratio [OR], 7.04 [95% confidence interval {CI}, 5.02-9.87]; group 4 vs group 1: OR, 6.07 [95% CI, 4.77-7.71]). Groups 3 and 4 were also more likely to meet depression symptom criteria (group 3 vs group 1: OR, 5.76 [95% CI, 4.34-7.65]; group 4 vs group 1: OR, 4.00 [95% CI, 3.16-5.06]). Respondents who met the PTSD symptom criteria were more likely to identify violence as a means to achieve peace (OR, 1.31; 95% CI, 1.05-1.65). Respondents who met the depression symptom criteria were less likely to identify nonviolence as a means to achieve peace (OR, 0.77; 95% CI, 0.65-0.93). CONCLUSIONS: Our study found high prevalence rates for symptoms of PTSD and depression in a conflict zone. Respondents reporting symptoms of PTSD and depression were more likely to favor violent over nonviolent means to end the conflict.

Rape in Armed Conflicts in the Democratic Republic of Congo: A Systematic Review of the Scientific Literature.

We conducted a systematic review of the scientific literature between 1996 and 2013 on rape in war-ridden Eastern Democratic Republic of Congo (DRC) in order to better understand the interest of the scientific community in describing the magnitude and characteristics of the problem. The literature search was conducted in French and English using several databases (Pubmed, PsycInfo, Sapphire, BDSP, Embase, Rero, and Web of Science) with the key words "rape and DRC" combined with several Medical Subject Headings concepts. Our systematic review yielded 2,087 references, among which only 27 are original studies, that is 20 are based on population surveys and the remaining 7 are original data based on case studies and reviews. Ten studies provided prevalence rates of rape victims, 18 provided specific information on the profile of the victims, 10 reported that most of the perpetrators of rape were military personnel, 14 referred to the negligence of the government in protecting victims, and 10 reported a lack of competent health-care facilities. The awareness of rape in conflict-ridden DRC is still limited as reported in the scientific literature: Published scientific papers are scarce. Yet more research would probably help mobilize local authorities and the international community against this basic human rights violation.

Mental Health Disorders Among Women Victims of Conflict-Related Sexual Violence in the Democratic Republic of Congo.

To assess the effects of sexual violence (SV) in armed conflicts on women's mental health, on its own and in conjunction with reproductive health issues such as fistula or chronic pelvic pain (CPP). A cross-sectional population-based study of 320 women living in Goma, the Democratic Republic of Congo, aged 15 to 45 years, was conducted. Women who experienced conflict-related sexual violence (CRSV) were compared with those who experienced non-conflict-related sexual violence (NCRSV) and those who never experienced such acts. Data were gathered through individual interviews by local staff using standardized questionnaires. The outcomes investigated were post-traumatic stress disorder (PTSD) symptoms severity and psychological distress symptoms (PDS) severity. Experience of SV in either context was associated with more severe PDS (p < .0001). Only CRSV was associated with more severe PTSD symptoms (p < .0001). Women who suffered from fistula or CPP also had a higher PDS score mean (p < .0001 and p = .007) and a higher PTSD symptoms score mean (p < .0001, for both reproductive health issues). Multivariate analyses showed that compared with women who never experienced SV and never suffered from fistula or CPP, those who experienced CRSV and suffered from fistula or CPP had the most severe PDS and PTSD symptoms after adjustment for potential confounders. The differences in PDS and PTSD symptoms severity were all significant (p < .0001). Psychological and physical health care are urgently needed for women who experienced CRSV, particularly those with additional issues of fistula or CPP. Current interventions should simultaneously seek to improve both reproductive and mental health.

Mobile autopsy teams in the investigation of war crimes in Kosovo 1999.

On request of the International Criminal Tribunal for the former Yugoslavia (ICTY), the Danish-Swedish forensic teams worked in Kosovo during the summer and the fall of 1999. The teams worked mainly as "mobile teams" at sites with few graves. Only two larger sites were examined. Most of the bodies were buried separately. A few "multiple burial" graves were examined, but no mass graves were encountered. The main purpose of the autopsies was to establish the cause and manner of death. Identification was of less importance, but a majority of the bodies had been identified prior to the autopsy. A total of 308 bodies, mainly males, were examined. The age varied greatly with a mean age of 47 years. The most common cause of death was gun shot wounds and the most common manner of death was homicide.

Crimes against humanity: the role of international courts.

We study the role of international tribunals, like the International Criminal Court (ICC), as an effective way of reducing the number and/or gravity of crimes against humanity. The action of the ICC is directed against leaders that promote or tolerate these kinds of crimes, that is, political authorities, army commanders, civil leaders, etc. In order to simulate the action of the ICC we build a hierarchical society where the most important leaders have the highest connectivity and can spread their points of view, or their orders, through a chain of less but still highly connected deputy chiefs or opinion chieftains. In this way, if they practice misconduct, corruption, or any kind of discriminatory or criminal actions against individuals or groups, it would very difficult and improbable that they will be prosecuted by the courts of their own country. It is to alleviate this situation that the ICC was created. Its mission is to process and condemn crimes against humanity though a supranational organism that can act on criminal leaders in any country. In this study, the action of the ICC is simulated by removing the corrupt leader and replacing it by a "decent" one. However, as the action of the corrupt leader could have spread among the population by the time the ICC acts, we try to determine if a unique action of the ICC is sufficient or if further actions are required, depending on the degree of deterioration of the human rights in the hypothetical country. The results evidence the positive effect of the ICC action with a relatively low number of interventions. The effect of the ICC is also compared with the action of the local national judiciary system.

Mental health consequences in men exposed to sexual abuse during the war in Croatia and Bosnia.

In the research project on sexual abuse of men during the war in Croatia and Bosnia and Herzegovina, detailed information from 60 victims of such crimes was gathered. The aim of the research was to define key attributes of sexual abuse of men in war as well as consequences it had on the victims. A method of structured interview was used. Also, the statement of each victim was recorded. Victims were exposed to physical torture of their genitals, psycho-sexual torture and physical abuse. The most common symptoms of traumatic reactions were sleep disturbances, concentration difficulties, night-mares and flashbacks, feelings of hopelessness, and different physical stress symptoms such as constant headaches, profuse sweating, and tachycardia. In addition to rape and different methods of sexual abuse, most of the victims were heavily beaten. The conclusion is made that the number of sexually abused men during the war must have been much higher than reported.

Human rights: from accountability to rebuilding.

Having surveyed more remote regions in Sierra Leone than anyone since the conflict ended, statistician Jana Asher of the AAAS Science and Human Rights Program is now reanalyzing the data she gathered on human-rights violations to document humanitarian needs. (Read more.).