The Sunday Times, 17 November 2019   17 mins read

Doctor Miracle: meet the man who has saved thousands of rape victims — many of them children and babies

The Sunday Times, 17 November 2019

17 mins read

Doctor Miracle: meet the man who has saved thousands of rape victims — many of them children and babies

On Friday October 5, 2018, Dr Denis Mukwege had started in surgery at 7.30am as usual. He was on his second operation when he heard patients and colleagues crying. At first he thought something terrible had happened. But when he came out in his scrubs everyone started hugging him. He had been awarded the Nobel peace prize, jointly with Nadia Murad, a young Yazidi activist, for their work highlighting the use of sexual violence as a weapon of war.

In his acceptance speech in Oslo in December, he said: “My name is Dr Mukwege. I come from one of the richest countries on the planet. Yet the people of my country are among the poorest of the world … My country is being systematically looted with the complicity of people claiming to be our leaders … The Congolese people have been humiliated, abused and massacred for more than two decades in plain sight of the international community.”

The country is the Democratic Republic of Congo and it has been endlessly plundered by its rulers for its gold, diamonds, copper and tin, often with the connivance of multinational mining companies. But in recent years other minerals have become important: those key to the technological revolution. DR Congo supplies two-thirds of the cobalt needed for the batteries of electric cars, mobile phones and laptops, as well as coltan, a dull black metallic ore from which comes tantalum, used to make capacitors. Companies that are household names rely on the country’s minerals, and probably every household in the West has at least one of their products.

Those riches have intensified the rivalry of militias that vie for control in lawless parts of the country. And part of the violence, as Mukwege knows only too well, is the use of rape as a weapon of war.

Over two decades he has treated more than 54,000 raped women and girls at his hospital in the east of DR Congo, and he thought he’d seen the worst of the worst.

Then, in 2014, he had to treat a baby who had been raped. “She was just 18 months and, really, I didn’t understand,” Mukwege says. “She was dying. We managed to save her, but, for me, it was really shocking. The nurses were all sobbing — it was the first time I had seen them crying while treating a patient. We prayed in silence, ‘My God, tell us what we are seeing isn’t true, that it’s a bad dream.’ But it wasn’t, it was the new reality.”

Despite the horrors and heavy personal cost, Mukwege kept working to help thousands of women and children. But the use of rape as a weapon has worsened, he says. “Now, if you look at the numbers of patients coming into the hospital, they are stable, but the big problem is the number of children is increasing,” he tells me when I visit Panzi Hospital in the militia-infested east of the country. “Ten years ago, 3% of our patients were under 10. Last year it was 6% and it’s going up.” The brutality of an already brutal land is getting worse.

“To do this to babies — this is not human,” he says. “When we let impunity take place, you authorise things even animals don’t do.”

Mukwege founded the hospital in the city of Bukavu 20 years ago to reduce the appalling number of mothers dying in childbirth, for which DR Congo is one of the worst places in the world. Even today, seven out of every 1,000 mothers dies in childbirth.

“My vision was to fight maternal mortality,” he tells me. “In France, where I finished my training as a gynaecologist, I had never seen a woman die giving birth, but in Congo it was so common that women uttered their last words when going into labour because they didn’t know if they would survive.”

After graduating from Burundi University in 1983 and returning home to Bukavu, where his father was a Pentecostal pastor, he moved to Lemera, a remote area to the south of the city, to work in its hospital. There, he began building small centres for women to give birth in and schools for training midwives. Within a few years they had drastically reduced maternal mortality.

“I was really happy with the results,” he says. “But then in 1996 the war started.”

Following the genocide in neighbouring Rwanda in 1994, hundreds of thousands of Hutus fled across the western border into the forests of what was then Zaire. Among them were many of the Interahamwe, a Hutu paramilitary group that had led the genocide, and they took control of the vast refugee camps that had sprung up around Goma and Bukavu. Soon the Tutsi-led Rwandan army of General Paul Kagame, who had ended the genocide and taken power in Kigali, the Rwandan capital, came in pursuit, sparking the First Congo War of 1996-97. With the support of Rwanda, rebel forces led by Laurent-Désiré Kabila swept from the east across the vast country that later became DR Congo. On the night of October 6, 1996, they attacked the rural Lemera hospital near Bukavu, where Mukwege was working as a paediatrician. He managed to evacuate some patients, but soldiers blocked the road behind him and he could not get back to help the rest. Some 33 patients were slaughtered in their beds as well as many staff.

“I suffered for a long time,” Mukwege says. “When I eventually returned to my senses, I came home to Bukavu, where I again saw the same problem of women dying needlessly in childbirth. I thought that to help women I didn’t need a big infrastructure, just a few boxes of equipment, a delivery room where I could do a caesarean, if necessary, and a couple of rooms where mothers could stay for a short period after birth. I could save lives doing small things because I had knowledge.”

“The first patient didn’t come to give birth. “It was a woman who had been raped by several men, and after raping her they shot through her vagina. I was so shocked I thought this must be an isolated incident carried out by someone on drugs who isn’t really conscious of what he is doing.” Over the next three months, 45 more women turned up, all with the same story.”

But then, in 1998, a second war started as the Rwandan and Ugandan backers of Kabila, who had become president of DR Congo, quickly tired of the corpulent leader and his dictatorial ways. It became the world’s deadliest conflict since the Second World War, drawing in nine countries and leaving around 4m people dead, and millions more displaced from their homes.

For Mukwege it was a disaster. His rooms were trashed and equipment was looted. So, in June 1999, he began treating pregnant women in tents. “That was how Panzi started,” he says. But the first patient didn’t come to give birth. “It was a woman who had been raped 500 metres away from my place by several men, and after raping her they shot through her vagina. I was so shocked I thought this must be an isolated incident carried out by someone on drugs who isn’t really conscious of what he is doing.”

Over the next three months, 45 more women turned up, all with the same story. One after another told him how they had been at home with their families when men with guns came and shot dead their husbands and raped the women. “Some were raped by five or more men till they lost consciousness,” he says. “All in front of their children. I realised then these militias were using rape as a weapon of war.”

Militias allied to different ethnic groups and different sides were all carrying out the rapes, while fighting for control of DR Congo’s precious minerals, which Mukwege believes have “cursed” its women rather than making the country rich.

Each group seemed to have its own signature torture, and the rapes were so violent that often the women suffered grievous physical wounds. “It’s not a sexual thing, it’s a way to destroy another, to take from inside the victim the sense of being a human, and to show you don’t exist, you are nothing,” he says. “It’s a deliberate strategy, raping a woman in front of her husband to humiliate him so he leaves and shame falls on the victim, and it’s impossible to live with the reality, so the first reaction is to leave the area and there is total destruction of the community. I’ve seen entire villages deserted. Rape as a weapon of war can displace a whole demographic and have the same effect as a conventional weapon but at much less cost.”

Twenty years on, Mukwege and his hospital have treated so many rape survivors that he is known as Dr Miracle. He and his team have developed a whole support system.

In a consulting room cheerfully decorated with Mickey Mouse and Pluto transfers sits little Violette, hair twisted into almost horizontal pigtails, eyes as wide as saucers, like a character from one of the cartoons on the walls. The anguish in those eyes as her mother, Amala, gently lifts up her orange and yellow patterned skirt is a snapshot of such terror that it imprints itself on the brain.

“I left her at home to work in the rice fields,” says Amala. “When I came home, she wasn’t in the compound, then I found her crying and bleeding with her clothes in her hand. I was scared and asked, ‘What happened? Did you fall?’ She said, ‘No, a man came and took me into the latrine behind the school, then put his hand over my mouth and hurt me.’ ” Violette was only four years old.

Her mother could not afford treatment, but a local health worker with links to Panzi Hospital arranged for them to travel the 350 miles east from their home town of Kindu by bus, plane and boat to Bukavu, where the hospital is. Doctors there sat Violette in salted water to soothe her wounds and she was seen by a psychologist.

One week on, the examining surgeon, Desire Alumetti, is planning to operate the next day. He wears a red baseball cap emblazoned with the words “Dr Mukwege My Hero” and a reassuring smile.

But Amala begins to cry. “My heart is broken,” she says. “I feel guilty because I left her, but I had no choice other than to go to the forest and earn money to buy food.”

Little Violette puts her head on her mum’s lap as if trying to shut out the world. Her mother takes her out and the door opens again. This time it is a young woman, breastfeeding a baby with a mass of curls. Initially I assume the woman is the patient. Instead, she lays the baby girl down to be examined. Her name is Chantal, she is only seven months old, and she immediately starts crying. I have never seen such fear in a baby’s eyes. “She cries whenever I put her down now,” says her mother, Anazo.

She explains that she had left the baby with her younger sister and gone to work in the fields when she heard shots. The village had been invaded by Raia Mutomboki, one of the most feared of the region’s many mai-mai, or militias, responsible for the murder and rape of hundreds of villagers, according to UN reports. They also kept women in caves as sex slaves.

“Rape can have the same effect as a conventional weapon, but at much less cost. I’ve seen entire villages deserted.”

“Everyone fears those men,” Anazo says. “My sister came to find me and said that she had run away and left the baby because the rebels had come. I ran home, but the house had already been attacked; they had taken the bag of rice and all my and the baby’s clothes. I found the baby on the bed crying, so I just took her and ran. But she wouldn’t stop crying. I tried to breastfeed but she wouldn’t eat. I didn’t know what was wrong. Then I took her to the medical centre. The doctor straight away saw she had been raped. When I heard that, my whole body was shaking. I felt like I’d lost control, I didn’t even know where I was. In our area, the rebels often came and destroyed houses and looted things, but this was the first time I had heard of anything like this.”

They had travelled about 160 miles from Kaloli village in Shabunda, a remote part of South Kivu province at the eastern edge of DR Congo, where gold had been found. It had brought misery rather than prosperity to the villagers by attracting militias.

The examination over, Anazo puts Chantal back to her breast. “I hope whoever did this will go to jail for years,” she says.

I ask Alumetti why an adult man would rape a tiny baby.

“Sometimes they do it to push people out of the area so they can exploit the minerals,” he says. “Sometimes they think it gives them power to make them invincible.”

I ask him what he would do for the baby. “We have given her an injection against hepatitis B and bathed her in antiseptic water against infection, then we will operate.”

Chantal would be the youngest baby Alumetti had ever operated on.

Panzi offers far more than medical treatment, as I saw while I wandered around the hospital grounds over the next few days. Mukwege’s experience has led him to pioneer a four-pillar holistic approach that is widely referred to as the Panzi model.

“What we discovered was that treating victims medically was not enough because of the trauma,” he explains. “So we hired a team of psychologists and began using art and music therapy. But even when the women recover mentally, we saw that to send them back to their villages was not a solution as most were discriminated against and rejected by their family and community.

“So the third pillar is socioeconomic support. If they are younger, we pay their school fees and support them. If they are pregnant, we have a safe house, Maison Dorcas, where we take care of them.

“For adult women we offer a literacy course and teach them different skills such as handicrafts, tailoring and agriculture so they can be independent. We teach them to set up mutual funds and we provide seeds and microloans for them to have small businesses. It’s a way for them not just to earn income but to be strong and to fight for their own rights.”

There is also a centre for babies born of rape as they tend to be rejected.

The fourth and final pillar is legal advice. “We find that once we have helped the women to be self-sufficient, they come back and say, ‘I want justice,’ so we have lawyers who can help them file cases.”

This, he says, is both part of the process of healing and key to changing the situation. “It’s not something of one day — it might be six months or even five years before a woman says, ‘I want to speak up.’ It takes time, but the only way we can change society is to end impunity. Because what is protecting perpetrators, even in Europe, is silence.

“We need to help women understand that what they went through is not normal, and that if they start to speak out, it is helping not only them but the community. Even these men have families, and when the women make public what they did, many [of the men] are afraid for their position in society and their own families.”

Setting up this whole system was not easy. “Many hospital staff didn’t believe it was part of healthcare and were resistant.”

His work began to attract attention overseas. Eve Ensler, the American playwright and feminist best known for The Vagina Monologues, has been an ardent fan since they first met in 2006 and he invited her to visit the hospital. “I couldn’t believe there was such a man on the planet devoting his life to ending sexual violence,” she says.

So impressed was she that she co-founded City of Joy, an inspirational centre for survivors, with Mukwege and Christine Schuler, a human rights activist.

Back home, however, Mukwege made powerful enemies for his criticism of the complicity of the government — much of the raping is carried out by the military. “I’ve had lots of threats,” he shrugs.

Inside City of Joy, an inspirational centre for survivors in the eastern Congo

In 2011 he was invited by Margot Wallstrom, the first United Nations special representative on sexual violence, to address the UN General Assembly in New York. When he got there, Mukwege says, a DR Congo official summoned him to his hotel. “He said, ‘You need to make a choice — either go home or stay and give your speech, in which case you take responsibility for what will happen to you and your family. My family was in Congo and I was in New York, so it was a clear threat. I decided to cancel.”

The following year, in September 2012, he was invited again to address the assembly, this time by William Hague, then Britain’s foreign secretary. Mukwege agreed and was outspoken in his criticism of the Kabila government.

When he returned home in October, five men with pistols and AK-47s were waiting. “They had taken my daughters hostage and started to shoot. I thought I was going to die. My guard of more than 25 years, Jeff, was killed in front of my daughters and I don’t know how I was saved.

“They did not do anything to my daughters, rape them or anything. But of course my daughters were waiting, thinking something might happen, which was terrifying.”

After their narrow escape, the family left the country for Belgium. But within two months women in Congo started to write to him, asking him to return. “One day I heard they were selling bananas and tomatoes to pay for my ticket, so I had to come back.”

In a sense the hospital has now become his prison: since the attack he has lived on site and has troops from the UN peacekeeping force Monusco protecting him. “We are always in danger,” he says. “I can’t move without security.” Even so, he says there is often gunfire. “They come round the hospital or my house and shoot.”

One of his colleagues, Dr Gilda, was killed in 2015, shot dead while working at a hospital in Kasenga, in the south of the country. “That was devastating to me,” Mukwege says.

His five children are grown up and, though he misses them, he is glad they are out of DR Congo — he worries that the country is slipping back into the horror of the late 1990s. “We are in a situation now of no war but no peace,” he says.

He has a son who is training to be a gynaecologist, and though Mukwege hoped he would follow in his footsteps at Panzi, he is now torn. “How can I ask him to come back when he has young children and I am living in a prison?” he asks.

Later, in his office in another part of the hospital, Mukwege wearily lowers himself onto the sofa next to me and shakes his head. A tall, lumbering man with the kindliest of faces, his eyes are bloodshot. It’s 2pm and the 64-year-old has already done four operations, two on rape victims.

Behind us, a group of young doctors sits around a table waiting for him to give them some training as part of the Panzi network he is trying to create across DR Congo, no easy task in a vast country about two-thirds the size of western Europe. As usual he had started at 7am, conducting prayers for the staff, and will probably work till 11pm.

It isn’t the workload that is weighing him down, though. “For the past five years, we are getting more and more babies,” he says. “How can these things happen and we don’t act? I have been crying for years to stop these things, but people are just denying them.”

I tell him that his Nobel address, in which he begged the world to take notice and act to stop DR Congo’s horrors, was one of the most powerful speeches I have ever heard.

“Everyone applauded but nothing happened,” he says sadly. “We need the UN Security Council to say no, the war in Congo is not acceptable, and action must be taken.”

Outside, a placard congratulating him on winning the Nobel prize lies discarded upside-down against a wall. Wailing starts up, then a crowd appears carrying aloft a wooden stretcher bearing the body of a young woman who did not survive.

“Maybe the Nobel is an honour, but our fight is not for an honour, it’s to stop what is happening to girls and babies in Congo,” Mukwege says. “Instead, it’s my impression we are going backwards.”

Some names have been changed

Picture credits: Christina Lamb; cover photograph by Nicolas Pinault/VOA (Wikimedia Commons)