We are still alive

173 Pages·2014·3.52 MB·English

"W e a r e s t il l a l i ve"
"We have been harmed bu t we are brave and strong. "
Research on the long-term consequences of war rape and coping
st rategies of survi vors in Bosnia and Herzegovina
Bosna i Hercegovina Bosnia and Herzegovina

”
We are still alive”
Research on the long-term consequences of war
rape and coping strategies of survivors in Bosnia
and Herzegovina
“We are still alive.
We have been harmed but we are brave and strong.”
June 2014
Zenica, Bosnia and Herzegovina
Research on the long-term consequences of war rape and coping strategies of survivors in Bosnia
and Herzegovina - “We are still alive. We have been harmed but we are brave and strong.” Second
revised edition.
Researchers: Sabiha Husić, M.Sc., Irma Šiljak, Emina Osmanović, Ferida Đekić, Lejla Heremić
Consultants: Dr. Simone Lindorfer, Dr. Elvira Duraković-Belko, Andreja Dugandžić, Nejra Čengić
Reference Group/ Editorial Team: Sabiha Husić, M.Sc., Dr. Elvira Duraković-Belko, Irma Šiljak,
Dr. Monika Hauser, Dr. Simone Lindorfer, Kirsten Wienberg, Karin Griese
Medica Zenica medica mondiale e.V.
Krivace 40 Hülchrather Straße 4
72000 Zenica, Bosnia and Herzegovina 50670 Cologne, Germany
Phone: 00387 (0) 32 463 920 Phone: [phone]
Fax: 00387 (0) 32 463 924 Fax: [phone]
http://www.medicazenica.org/index.php www.medicamondiale.org
[email protected] [email protected]
Layout: Samir Kamenjaš/Dobra knjiga, Sarajevo
Translation: Halima Husić, Erma Mulabdić, Mediha Haskić
Warm thanks to Anthony Arthur for editing and proofreading.
This publication was supported by a grant from the Open Society Foundations (OSF) New York, United States; from
FONDATION SMARTPEACE (Initiatives for Peace), Zurich, Switzerland and medica mondiale e.V., Cologne , Germany
Research on the long-term consequences of war rape and coping strategies of survivors in Bosnia
and Herzegovina - “We are still alive. We have been harmed but we are brave and strong.” Second revised
edition. (November 2014). Medica Zenica & medica mondiale. Zenica, Bosnia and Herzegovina
CIP - Katalogizacija u publikaciji
Nacionalna i univerzitetska biblioteka
Bosne i Hercegovine, Sarajevo
159.97:355.01]:341.48(497.6)
We are still alive: Research on the long-term
consequences of war rape and coping strategies of
survivors in Bosnia and Herzegovina / [editorial
team Sabiha Husić ... [et al.] ; translation
Halima Husić, Erma Mulabdić, Mediha Haskić]. -
Zenica : Medica, 2014. - 169 str. ; 31 cm
Bibliografija i bilješke uz tekst.
ISBN 978-9958-9576-8-0
1. Husić, Sabiha
COBISS.BH-ID 21366534 
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Contents
Acknowledgements .............................................................................................................9
Foreword ...........................................................................................................................11
Summary ...........................................................................................................................13
1. Introduction: Background to the research and evaluation project .........................................15
1.1. Why conduct research on war rape 20 years after the war in
Bosnia and Herzegovina? .........................................................................................15
1.2. Values guiding this research and evaluation project ................................................17
1.2.1. We follow a feminist research paradigm ............................................................17
1.2.2. We follow the ethical principle of trauma-sensitivity .........................................18
1.2.3. We favour a systemic perspective on the consequences of war rape,
informed by feminist values ...............................................................................20
1.3. The structure of the evaluation and research report ...............................................21
2. The theoretical framework of the study .........................................................................23
2.1. War rape and sexual violence in the war in Bosnia and Herzegovina .......................23
2.2. The aftermath of war rape: the multiple consequences of war rape on the
lives of survivors – theoretical background to research question 1 ........................26
2.2.1. Introductory comments: the paucity of scientific research on the
consequences of war rape .................................................................................26
2.2.2. War and its multiple traumatisation ...................................................................28
2.2.2.1. I mpact of war experiences on the mental health of its survivors:
international experiences and the specific case of Bosnia and Herzegovina ......28
2.2.2.2. The impact of post-war stressors on mental health: When “war is not
over with the last bullet” ..............................................................................30
2.2.3. Rape and its consequences for the survivors .....................................................31
2.2.3.1. What makes rape such a destructive experience? Psychological
dynamics and their meaning for survivors ..................................................31
2.2.3.2. The multiple impact of rape on the mental health of survivors ....................32
2.2.3.3. Physical health and rape ..............................................................................33
2.2.3.4. Research on war rape with particular focus on war rape in
Bosnia and Herzegovina and Croatia ...........................................................33
2.2.4. The long-term consequences of extreme trauma: Does time heal? ...................34
2.2.4.1. Longitudinal aspects for the recovery from trauma in general ....................34
2.2.4.2. Specific longitudinal aspects of the trauma of (war) rape ............................35
2.2.4.3. Looking at the next generation: aspects of transgenerational
transmission of trauma ...............................................................................36
2.3. The need for social acknowledgment of war rape survivors - theoretical
background to research question 2 .........................................................................37
2.3.1. Research on the importance of social acknowledgement ..................................37
2.3.2. Exemplary aspects of social acknowledgement of war rape survivors in
Bosnia and Herzegovina: religious messages and the status of the
civil victim of war ................................................................................................39
2.4. Living with the legacy of war rape: strategies of coping and resilience building
in survivors of war rape trauma - theoretical background to research question 3 .....42
2.4.1. Why do some survivors recover more easily than others? Introduction to
key concepts .......................................................................................................42
2.4.2. Risk factors related to war and rape trauma (with special regard to research
from Bosnia and Herzegovina) ............................................................................44
2.4.3. Coping strategies associated with severity of PTSD amongst rape survivors ....45
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Research on the long-term consequences of war rape and coping strategies of survivors in Bosnia and Herzegovina
2.4.4. What role does “social support” play in buffering war- and rape-related
stress? ...............................................................................................................47
2.4.5. The special role of self-blame for survivors of rape ..........................................49
2.4.6. Is post-traumatic growth after war and rape possible? .....................................50
2.5. Helping survivors of war rape in their recovery from trauma: What helps and
why? - theoretical background to research question 4 .........................................51
2.5.1. Introductory comments: Do survivors of trauma seek psychosocial
support / therapy? And if yes, why? ...................................................................51
2.5.2. Psychosocial assistance in Bosnia and Herzegovina and Croatia during
and after the war: key issues and contextual responses ...................................52
3.Methodology of the study ...............................................................................................55
3.1. Introduction to the methodological design and main characteristics of the study ...55
3.2. Instruments/techniques used in the research (see also annex) ..............................56
3.2.1. Quantitative measures used for the purpose of the research ............................56
3.2.2. Qualitative methods – Part 1: data from governmental institutions and NGOs ...59
3.2.2.1. Key informant interviews with governmental institutions ...........................59
3.2.2.2. Key informant interviews and focus group discussions with NGOs ..............59
3.2.3. Q ualitative methods - Part 2: data from survivors through life story interviews...60
3.3. Characteristics of the participants ..........................................................................61
3.3.1. Women survivors of war rape and sexual violence (included in the
quantitative study) .............................................................................................61
3.3.1.1. General challenges in the preparatory phase ..............................................61
3.3.1.2. Information about the survivors who used the services of Medica Zenica
but did not participate in the research ..........................................................62
3.3.1.3. Information on participants in the quantitative study ...................................63
3.3.2. Selection of participants for the 7 life stories ....................................................65
3.4. Limitations of the study ...........................................................................................67
4.RESEARCH RESULTS ......................................................................................................69
4.1. Research question 1: Impact of the experience of war rape and sexual violence
on survivors’ lives: Results obtained from the psychometric tests, questionnaire
and focus group discussions with NGOs ...................................................................69
4.1.1. The multiple traumatisation of war: What do survivors of war rape perceive
as (the most) difficult experiences that they went through? ..............................69
4.1.2. Impact of war rape on psychological health: Prevalence of PTSD and other
measures of psychological distress ...................................................................70
4.1.3. Participants’ perception of the long-term impact of war rape ...........................74
4.1.4. Influence of war rape and sexual violence on the physical health of
survivors (health in general, as well as specifically gynaecological/
reproductive health) ..........................................................................................76
4.1.5. How did the war rape and sexual violence influence the survivors’
relationships with their families as a whole? .....................................................79
4.1.6. How did the war rape and sexual violence impact on the survivors’
relationships with husbands/partners and men in general? ............................. 81
4.1.7. How did war rape and sexual violence impact on survivors’ relationships
with their children? ............................................................................................82
4.2. R esearch question 1: Impact of the experience of war rape and sexual violence
on survivors’ lives: Results obtained through the analysis of survivors’ life stories ...84
4.3. Conclusions regarding research question 1 ........................................................... 91
4.4. Research question 2: Social acknowledgement: How does Bosnian society treat
survivors of war rape today? And how do survivors assess the support and
recognition they are given from society? Results obtained from the
questionnaire and focus group discussion with NGOs .............................................93
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Research on the long-term consequences of war rape and coping strategies of survivors in Bosnia and Herzegovina
4.4.1. Participants’ perceptions of societal responses towards war rape survivors ....93
4.4.2. Survivors of war rape and information and access to their rights .....................96
4.4.3. Do survivors keep silent or talk about their difficult experience with others? ...99
4.4.4. Problems interfering with the successful recognition of survivors of war
rape in the society (from the perspective of the non-governmental
organisations and government institutions) .....................................................101
4.4.5. G eneral problems experienced in the work of non-government organisations ..104
4.5. Research question 2: Social acknowledgement: How does Bosnian society treat
survivors of war rape today? And how do survivors assess the support and
recognition from society? Results obtained through the analysis of survivors’
life stories .............................................................................................................105
4.6. Conclusions regarding research question 2 .......................................................... 112
4.7. Research question 3: Coming to terms with war rape: coping strategies
and sources of resilience: Results obtained through the coping inventory,
questionnaire and focus group discussions with NGOs ..........................................114
4.7.1. What coping strategies are used by the participants? ......................................114
4.7.2. Does coping get easier or harder with time? ....................................................116
4.7.3. Sources of resilience: What helps survivors of war rape? ...............................118
4.7.4. Speaking up or breaking the silence as particularly important coping
strategies after war rape (views from NGOs) ...................................................120
4.7.5. Is post-traumatic growth possible after war rape? .........................................121
4.8. Research question 3: Coming to terms with war rape: coping strategies and
processes and sources of resilience: Results obtained through the analysis
of survivors’ life stories ..........................................................................................122
4.9. Conclusions regarding research question 3 .......................................................... 125
4.10. Research question 4: The importance and impact of Medica on survivors’
recovery - Results obtained from the questionnaire ............................................127
4.10.1. Reasons for using Medica Zenica’s services and circumstances of first contact ...127
4.10.2. The duration and kinds of services accessed through Medica ........................128
4.10.3. Which services were useful and what was useful in the services provided? ..130
4.11. Research question 4: The importance and impact of Medica on survivors’
recovery - Results obtained through the analysis of survivors’ life stories .........132
4.12. Conclusions regarding research question 4 ........................................................ 135
5.Recommendations .......................................................................................................137
5.1. Regarding support programmes for survivors in general: .....................................139
5.2. Regarding specialised psychosocial programmes for survivors, and trauma
sensitivity in the legal, psychosocial and health professional domains: ................140
5.3. Regarding the special state law on the status of civilian victim of war: .................142
5.4. Regarding protecting survivors of war rape while testifying: ................................143
5.5. Regarding social acknowledgement of survivors (Special recommendations to
the society and communities of Bosnia and Herzegovina) : .................................... 143
APPENDIX
Questionnaire ....................................................................................................................145
Focus Group Discussion Guide for other organisations working with survivors of rape ..159
Key informant interviews for government officials of Ministries ..................................161
References ....................................................................................................................163
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Medica Zenica is the oldest expert medica mondiale is a German based fem-
non-governmental organisation which inist women’s rights organisation sup-
has been, since April 1993, continuously porting women and girls in war and con-
providing help, support and care to wom- flict regions. medica mondiale provides
en and children survivors of war rape psychosocial and legal counselling and
and sexual violence. Our approach to trauma sensitive medical consultation,
women and children, survivors of war and enhances protection – both through
rape, sexual violence and trauma, is based its own projects and in cooperation with
on humanistic values. Medica Zenica pro- local women’s organisations. At a politi-
vides education of professionals working cal level, medica mondiale actively advo-
with survivors, lobbies and advocates the cates the enforcement of women’s rights
improvement of the life quality of survi- and interests and demands consistent
vors as well as establishes networks that punishment of crimes as well as effective
enable survivors of war rape and sexual protection, justice and political owner-
violence to know when, where and how ship for women survivors of sexual and
to exercise their rights. In the past almost gender based violence.
22 years of active work with survivors of
trauma, Medica Zenica has provided more
than 400,000 various services across
Bosnia and Herzegovina.
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Acknowledgements
This research has been many years in We wish to thank our colleagues in
the making, so a complete list of all the Medica Zenica and medica mondiale who
people we would like to thank would be provided us with constant support and
prohibitively long. We would therefore encouragement.
like to take this opportunity to extend our
We would also like to take this oppor-
deeply-felt appreciation to everyone who
tunity to thank our families and friends
has made it possible.
who believed in what we were doing and
But above all, we know that this research encouraged and supported us throughout
could not have been done without the the project because they share the values
courage of the women survivors in Bos- that underpin our work, our wish that
nia and Herzegovina who took the brave future generations can learn and benefit
decision to participate in this research. from this research, and our hope that it
By sharing your experiences with us, we will contribute to reaching a day when
learned a lot from you. Thank you for rape and sexual violence are no longer so
your trust and time! This research is ded- prevalent in our society.
icated to you, and also to the women sur-
And of course, many thanks to our donors
vivors who remain silent, in the hope that
who supported our research and helped us
you will be motivated to speak out.
to record a part of these survivors’ history
We would like to especially thank the re- so we can learn from them how to help
search team in Bosnia and Herzegovina others.
and our experts, consultants and advisors
This research has had its own history and
for their commitment and determination.
dynamics; it was a challenge and all of
It was both challenging and inspiring to
us who were involved in this process feel
work with you all! We equally want to
that we are not the same as in the begin-
thank our interview partners in govern-
ning.
mental institutions and in non-govern-
mental organisations who shared their
valuable insights with us.
Sabiha Husic, M.Sc. Kirsten Wienberg
Director Head of Evaluation and Quality Department
Medica Zenica medica mondiale
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