Living Nightmare

03.13.1410:06 AM ET

Healing the Wounds of Genocide

Two decades after a nightmare of slaughter and terror, Rwanda’s rape victims are only now beginning to receive the help they need to heal.

Constance didn’t tell anyone what happened to her during the 1994 Rwanda genocide. But nearly ten years later, it was still written in her blood.

Plagued by headaches and back pain, Constance visited a clinic in 2005. When the nurses ran tests and said she was HIV-positive, she dismissed it–AIDS was a disease of loose women, she thought, not loyal wives. Yet the nurses insisted that she would die without medication. They also said there were other women like her–war widows who’d been raped and infected with the disease–and that she could talk with them.

Constance, in her early 50s, began attending group therapy through AVEGA, a non-profit that helps women widowed during the 1994 genocide that killed roughly one million Tutsis and moderate Hutus in just three months. Rape was used as a weapon during the bloodbath, and roughly 500,000 women were sexually assaulted, many of them tortured or mutilated, as well. Scarce mental health services for rape victims led AVEGA to start offering trauma counseling and therapy groups. In 2011, the organization hired 38 psychologists and trained more than 1,000 community volunteers to educate people about common trauma symptoms, such as chronic headaches and depression.

As Rwanda commemorates the 20th anniversary of the genocide in April, counselors say many rape victims are just now coming forward for treatment, while countless others are too ashamed or afraid to seek help. And in spite of AVEGA’s efforts, those who do seek treatment still face a lack of options. Many rural women live far from any healthcare services, and while the government does have a small number of therapists, most public mental health resources are directed at severe mental illness at inpatient facilities.

Constance says she wishes more women could take advantage of the group therapy in which she participated for about a year. While she was nervous at first, she says the group became one of the greatest blessings of her life. “I never talked about what happened to me for fear of being rejected, judged, or misbelieved,” Constance said on a January afternoon at AVEGA’s Kigali offices, sitting with her hands folded in her lap over her orange and green traditional skirt. “Listening to the others’ stories, I began to open up and talk, and I grew very close to the other women. It helped me a lot.”

Constance’s nightmare began in April 1994, when a group of young men armed with machetes appeared at the door of the hut she shared with her husband and four children in a western Rwanda village. They hauled her husband away. As days passed, Constance remained in the hut with her small children and infant, praying for her husband’s return. Yet when one of the armed men came back, her husband wasn’t with him. “Your husband is dead,” the man said. “Be my second wife or you’ll join him.” To survive and care for her children, Constance obeyed. She recoiled in horror at sleeping with her husband’s killer, but she feared he would murder her and her children if she resisted. He went on killing sprees by day and returned to brutalize her at night. “I wanted to die,” she said. This went on for months.

Once the Tutsi-led Rwandan Patriotic Front routed the genocidal government and its forces began fleeing the country, Constance’s rapist left, probably crossing the nearby border into Congo. Constance did her best to care for her children by cultivating bananas and vegetables. She went on anti-retroviral drugs and received a stipend from a survivors’ fund. Through it all, she drew strength from attending group therapy. “I listened to what people went through–people hacked with machetes, people who lost all of their children–and I would think, ‘I’m not alone, and people experienced worse,’” she said.   

Though groups like AVEGA have made progress, there is still a troubling lack of services for Rwanda’s survivors. “There’s only around one psychologist for each district, which is a real shortage,” says Adelite Mukamana, a psychologist who leads group therapy for victims as part of IBUKA, a network of organizations dedicated to helping genocide survivors (the country’s population is around 12 million and there are 30 districts, so that would be one therapist for around 400,000 people). “We have group therapy to reach the largest number of people, but we are so few, and there are so many who need help.”

Mukamana, whose group meets for two hours twice each month and usually draws about 25 women, says it’s crucial for women to be able to process and release traumatic memories in a safe, confidential environment. “Many of these women lost their entire families and have no one left,” she says. “The group is like a container that can hold those emotions, those memories of unspeakable horror.”

Francois Murekatete, AVEGA’s mental health services coordinator, says it will be crucial to have counselors posted at this year’s 20th commemoration events throughout April, since many women can become re-traumatized while listening to survivor testimonies. This is both a problem and an opportunity, since the overwhelming emotions often prompt survivors to seek treatment instead of continuing to suffer alone with symptoms of PTSD.

“Twenty years is actually not a very long time to recover when you’re talking about the level of trauma that happened here,” says Murekatete. “All the time we get new clients who are only now coming for help.”