Final Project: Crisis in Rwanda
Rhonda K. Dasher
Walden University

FPSY6740-01
Dr. Tracy Mallett
November 17, 2013

Abstract
The following review is based on the 1994 genocide which occurred in the small sovereign state of Rwanda, with a specific concentration on the rape victims and the consequences of the attacks. The review will describe the crisis intervention approach as well as any legal, ethical, or multicultural considerations concerning the crisis. Followed by an assessment of the impact of the victims as well as the global community will be offered. Furthermore a description of crisis intervention skills and strategies which would be best suited for this particular crisis and the potential for long term effects including risk and resilience factors. The review will conclude with trends or possible research related to the crisis in Rwanda.

Crisis in Rwanda President Clinton once stated “each bloodletting hastens the next, and as the value of human life is degraded and violence becomes tolerated, the unimaginable becomes more conceivable” (Goodreads, 2013). On April 7, 1994 madness swept through Rwanda as a mass genocide began, the slaughter of thousands of men, women, and children would continue for the next 100 days. The mass killings were only part of the story of what was occurring in Rwanda, thousands of women and young girls were raped and sexually tortured. For those that survived the consequences of the aftermath were significant, in many cases the victims became pregnant and/or had been exposed to the deadly HIV virus. The purpose of this review is to describe the application of concepts, principles, and theories related to crisis, trauma, and disaster with a specific concentration on the female rape survivors in Rwanda. * A Brief History of the Crisis Rwanda is a sovereign state which covers part of Central and East Africa, made up primarily of three groups, the Hutu, Tutsi, and Twa. Long standing political tensions between the Hutu and the Tutsi existed long before the genocide however as the world would soon learn, the conflict between the two groups had less to do with politics and more to do with ethnic hatred (Nowrojee, n.d).The genocide in Rwanda was the fastest growing and most vigorous genocide in the recorded history of the world, claiming the lives of 800,000 to a million people. Thousands of women and young girls were raped and sexually tortured. The question as to why rape became a key part of the genocide is much easier to answer than how those affected have been able to cope with the loss of loved ones as well as the trauma of rape. Since the beginning of time women have been viewed as spoils of war however in Rwanda rape was used as a weapon in which Tutsi women were systematically raped by the troops following orders from the Hutu leaders (Mukamana, & Brysiewicz, 2008).
Multicultural Approach Cultural competence is a set of congruent behaviors, attitudes, and policies which come together in a system (agency, or professionals) which enables that system to work effectively in cross cultural situations (King, 2009).Using the multicultural approach seems to be the best option when working with the victims in Rwanda, as it is vitally important to understand and interpret the various cultural aspect of the event. Understand the difference of religious beliefs, life experiences and vulnerabilities of the victims can assist the responder in being more culturally effective. Dykeman (2005) explains that the quick development of rapport and trust between the responder and the people of different cultures often require communication both verbal and non-verbal. Working with rape victims in Rwanda it is important for the worker to fully understand various things about their culture including how women are viewed by society as less than second class citizens, that it is a male dominated society and furthermore in Rwanda even before the genocide “rape” carried a certain stigma, women who had been raped were marginalized and seen as unfit to marry. Marriageability is determined by a girl’s virginity therefore girls and women who had been raped upset the culture’s normative standards. Only after a marriage could a girl be considered a woman, therefore virginity is an important part of their self-identity (Sai, n.d).
Theories of Crisis

Obviously there is no one single theory which can encompass every crisis however for the purpose of this review we will examine two which may be the most fitting. Chaos theory while not overly popular does seem to apply to the happenings in Rwanda, as it was an evolution applied to human functioning that was open ended and ever changing. The initial crisis of the genocide slowly led way into the realization of another crisis being the rape and sexual torture of thousands of victims, this in and of itself created a messy situation and hindered intervention attempts. Understandably many of these victims were already in crisis due to the killings of family and friends only to be sexually victimized which added to the ongoing crisis. Situational crisis can emerge from an occurrence of “uncommon and extraordinary events” whereas the victim has no warning or any way to control the situation. What makes a situational crisis different from other crisis is that the event(s) are often random, shocking, intense, sudden, and catastrophic (James, & Gilliland, 2013).
Moreover in a crisis of this magnitude the ACT model is ideal as it uses the following seven critical stages. 1. Planning and conducting a crisis/biopsychosocial assessment as well as assessing safety & lethality 2. Establishing rapport and a collaborative relationship with the victim(s). 3. Identification of the presenting problem or the crisis precipitant. 4. Exploring feelings and emotions. 5. Generating and exploring alternatives. 6. Developing a plan of action. 7. Follow up plan and agreement.
This plan has been specifically designed to deal with the traumatic events as well as behavioral emergencies. Considerations Related to the Crisis An analysis of the various considerations when dealing with those affected by crisis, trauma, or disasters include ethical, legal, and multicultural. Specifically in the case of rape victims the ethical considerations should include describing confidentiality and informed consent to name a few. These should be explained using the victim’s first language and be offered both written and orally. Some of the legal issues may include privacy, confidentiality, and duty to warn if applicable. The multicultural considerations particularly in this case may be extensive and include such issues as language barriers and cultural bias (James, & Gilliland, 2013).
Assessment of Rwandan Victims The impact of the trauma brought about by the rape and sexual torture of the victims in Rwanda in the following areas:
Affect: The victims presented with shame, anxiety, fear, anger, depression, and confusion. These feelings are common and may be expressed either verbally or non-verbally and it is important to keep in mind that their affective behavior may be influenced by gender and culture.
Behavior: The victims may present with excessive behaviors, acting out, or they may present as withdrawn or immobilized.
Cognition: This area deals with the victim’s thoughts and beliefs, self-image, life goals, religious and cultural beliefs. Victims of this type of trauma may appear disorganized, confused, or chaotic.
Development: This area brings us back to situational crisis and it is important to understand the victim’s life needs, concerns, and tasks affected by the trauma. The professional should assess any developmental capacities in relevant areas.
Ecosystem: This area is in regards to the culture and ethnicity of the victim. Note the presence or absence as well as the accessibility to inter personal formal, or informal resources and supports. Note any perceived barriers as well as the victim’s ability and/or willingness to utilize support (Collins, & Collins, 2005).
Global Impact of Crisis in Rwanda The world bore witness to the incredible carnage as well as the sexual torture and rapes of thousands in Rwanda, as time went on the devastation became more and more implausible. For the first time in recorded history the transmission of a potentially deadly virus was being used as a weapon of war and being administered through sexual savagery. Human immunodeficiency virus (HIV) infected men were specifically recruited in order to assist in the rape of women and young girls in order to pass on the virus which leads to acquired immunodeficiency syndrome (AIDS). The implementation of using systematic rape in war time is fast becoming known as “sexual terrorism”, collective sexual violence (CSV). The impact of the Rwandan genocide and rapes were wide spread and devastating for the victims (Lalla-Nalini, n.d). Besides the transmission of HIV, innumerable unwanted pregnancies resulted from the rapes, the Rwandan population office estimated upwards of 5,000 rape related pregnancies however there are no actual statistics therefore it could be much higher. Human rights violations became apparent during the 100 days, these atrocities in Rwanda had an impetus impact on the creation of the International Criminal Tribunal for Rwanda (ICTR). Located in Rwanda it provides a binding obligation on all member states to cooperate fully with the resolution and the Tribunal. The purpose of the Tribunal is to prosecute those responsible for the genocide and other serious violations of international humanitarian law as well as forbidding any future occurrences. The violations of the resolutions are retroactive for the entire year of 1994 (Lalla-Nalini, n.d).
Strategies and Skills Consequently responding to the aftermath of the crisis situation in Rwanda and dealing with victims of rape trauma it is imperative to utilize certain crisis intervention skills and strategies. The following is an example of how I, as a professional would utilize various skill and strategies to administer psychological first aid. Upon entering the setting it is important to understand the dynamics of the Incident Command System (ICS) if applicable and knowing exactly what my role and decision making capabilities are. Managing the setting includes communication and coordination with all authorized personnel, policies and procedures, security, and any available support services. In order to be as effective as possible it is imperative to learn as much as possible about the types of services and where they may be, information must be gathered quickly but more importantly is the accuracy of the information. As an illustration in this particular case since we are dealing with victims of rape it is essential to remember that according to James (2013) “nowhere in crisis intervention is it more important to provide the core facilitative conditions” such as building trust, displaying unconditional positive regard, use empathetic listening and responding, provide concreteness and clarity ,and demonstrate patience”. Core actions should always begin with “Contact and Engagement” during this time is where the responder may assess the problem as well as the severity. In addition during the initial contact it is very important to introduce yourself, explain your role and let them know you are there to help. All the while it is important to be culturally aware, as it is vital to understand what is considered culturally acceptable in order not to disrespect the victims culture by inappropriate touching , prolonged eye contact, invasion of their personal space just to name a few. Following this further, Safety and Comfort, is an opportunity to ensure the victims she is safe, be empathetic, genuine, and provide physical and emotional comfort. Remember many of these victims lost loved ones in the genocide so it is an opportunity to address grief and spiritual issues, and help them with any death notifications. Stabilization if necessary is a time when the responder may offer emotional calm and orient the victim. Information gathering consists of dealing with the victim’s current needs and concerns as well as tailoring any specific needs. Practical needs of the victim, in this case it may include medical help, food, and/or housing. Connection with social supports is used to help establish contacts either brief or ongoing support for the victim with primary support persons in her life such as family friends, church, and possibly community helping resources. Information and coping in this case would be to provide the victim with a variety of information about stress reductions and coping to reduce distress and promote adaptive functioning. Lastly using the linkage with collaborative services enables the provider to assist the victim with services which are available to her now as well as in the future (Psychological First Aid Field Operations Guide, 2006).
Potential Long Term Effects Another key point in the aftermath of the crisis in Rwanda is the potential for long term effects on the victims. While a crisis is normally time limited to approximately six to eight weeks it is important to remember what happens in the aftermath often determines whether the victim will be chronically affected by the trauma causing long term emotional, physical, and mental difficulties. Albeit the original crisis has passed new stressors may bring the victim to the crisis state again .The immediate aftermath of a trauma such as rape is a critical time for both the victim and the worker as the worker must walk a fine line and attempt to build a working alliance. Sensitivity is critical as the victim is experiencing physical and emotional pain, therefore as the worker gathers information and assess the victim’s state of mobility and equilibrium, empathy and constant reassurance of safety and security is vital (James, & Gilliland, 2013). Various research has shown that victims of sexual assault are far more likely to present with PTSD, as many as 50% of all rape victims are diagnosed with PTSD. Combat is the number one factor for those diagnosed with PTSD followed by rape victims. PTSD is not the only mental health disorder associated with sexual assault. Recent research has shown that sexual assault is an established risk factor for various mental health disorders including Post Traumatic Stress Disorder (PTSD), Major Depressive Episodes (MDE), as well as other mental health issues. Research has found that the risk is significantly higher of comorbid PTSD and depression in rape victims compared to non-victims (Zinzow, Resnick, McCauley, Amstadter, Ruggerio, & Kilpatrick, 2012). Another potential long term effect is the correlation of rape and substance abuse. Many victims turn to substances in order to self-medicate. Research has found a high incidence of comorbid PTSD and substance abuse, women substance abusers show much higher rates of this dual diagnosis (Najavitis, Weiss, & Shaw, n.d).Further research in this area may also prove to be quite beneficial in many areas including risk factors.
Risk and Resilience Factors A great number of studies have been conducted to examine the effects various risk factors have in promoting the development of PTSD in victims. Studies have shown that women in general are far more likely to develop PTSD than their male counterparts. Other risk factors may include the age of the victim at the time of the trauma, any family history of mental illness, as well as a history of being separated for periods of time from their parents during childhood. Lack of coping skills are also considered a risk factor (Voges, & Romney, n.d). Resilience factors may include such things such as the victim having a positive attitude, motivation, self-esteem, self-confidence, feeling safe and protected, as well as the support of a loving family and supportive friends. Recovery chances are greatly increased when a victim has a voice and often time’s validation plays an integral role. Many victims fail to report the offense to the police for a myriad of reasons including shame, guilt, and embarrassment. Fear is another factor commonly found in rape survivors, fear of retaliation, fear of the medical and legal community, fear of not being believed, as well as cultural considerations including the stigma attached (Kelly, 2008). Obviously we know many of the services needed to assist a victim in her recovery however it has been shown in various studies that often the delivery of those services by uncaring, untrained, workers hinder a victim’s chance of recovery. It is important to realize that the aforementioned information is in general, if we look at those same risk and resilience factors specific to Rwandan rape survivors the situation is much grayer. The status of women in Rwanda has never been good however since the genocide it has only gotten worse, while women make up 70% of the post genocide Rwanda they still face significant discrimination and serious health problems. Rwandan society has always held the males in high regards whereas women are made to be dependent on a male relative either father, brother, or spouse this made it near impossible following the genocide for women to reclaim their home and property (Human Rights Watch, 1996). Rwanda for the most part is a rural setting and the majority of these women are uneducated, have never had paid income, a voice in local or governmental politics, and are unable to obtain credit. Besides rampant poverty many of these women have serious health issues including HIV, AIDS, and scarring from sexual mutilation. Health care for women is next to non-existent and many are still struggling with serious emotional issues including the stigma rape, sexually transmitted diseases, and unwanted pregnancy (Human Rights Watch, 1996).

Trends and/or Future Research Consequently we know rape has been used in war time to inflict physical, psychological, cultural and social damage. In order to address the psychological damage of collective sexual violence further research is needed in order to understand and address post conflict damage and help the victims in their recovery goal. The atrocities committed in Rwanda were deplorable and it is up to the global community as well as policy makers to hold those accountable for human rights violations in order to stop the siege on women. A great start was made with the implementation of the Tribunal (ICTR) and making rape a war crime and a crime against humanity. An analysis of the literature shows there is still a great deal of research needed in the area of collective sexual violence (CVS) particularly among the genocide –rape survivors. Besides the research other services such as high quality, holistic health and mental health care services are also desperately needed (Zraly, Rubin-Smith, & Betancourt, 2011).
Conclusion
In summary, the tragic events of 1994 have left long term adverse effects on the thousands of victims traumatized not only by the mass killings but also by rape and sexual mutilation, transmission of HIV, and for many an unwanted pregnancy. Unfortunately many of these victims will continue on in a transcrisis state due in part to the lack of crisis intervention and resources needed. It is this author’s opinion that the long term effects which continue to linger in the mind and bodies of these victims are a direct cause of the social climate of Rwanda. A male oriented environment which holds women in such disregard that it prevents many of these victims treatment, services, or any other opportunities to recover and that, in and of itself is a definite crime against humanity.
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