Introduction

It is generally known that during the 100 days of genocide against the Tutsi in Rwanda in 1994, sexual violence was committed on an unprecedented scale. Many women were first raped and then killed. With a certain degree of probability, the majority of Tutsi women who survived had been raped. Limited information is available regarding the experiences of these women. However, there is enough empirical evidence provided in human rights accounts and research reports substantiating that these women were exposed to unimaginable horror, which for the majority of them had a range of devastating short and long term effects. The programme of community-based sociotherapy was implemented in 2005 in the north of Rwanda in what was previously known as Byumba province, and subsequently in 2008 in Bugesera district in the south-east, one of the epicentres of the genocide.     &nbsp

Conclusion

By way of conclusion I will extract a few themes from the stories I regard as relevant to take into consideration for the purpose of supporting the women who told their stories and advancing their case

“We are the memory representation of our parents”: Intergenerational legacies of genocide among descendants of rape survivors in Rwanda

Introduction: The 1994 genocide against the Tutsi in Rwanda subjected thousands of women to rape as part of a range of other genocidal atrocities. This article explores what it means in everyday life to be a descendant of such mothers. Methods: A qualitative study was conducted in eastern Rwanda. The twelve respondents, all descendants of genocide-rape survivor mothers, participated in focus group discussions and semi-structured interviews. Topics focused on different aspects of the intergenerational transmission of trauma and the mitigation of this transmission by the psychosocial support from which their mothers benefited. The phenomenological method as developed by Giorgi (2012) was used to analyze the transcripts. Findings: All respondents, regardless of their birth circumstances, are marked by growing up with a severely traumatized mother. Children conceived during rape are specifically marked by the absence of a perpetrator father unknown to them, the others by the lack of many (extended) family members. They all benefited from the psychosocial support provided to their mothers. Discussion: Genocidal rape causes specific kinds of suffering and specific identity problems for the children born as a consequence of genocide-rape. However, even if the children were not conceived during the rape, their level of suffering is similar. Conclusion: The effects of the intergenerational transmission of trauma related to the 1994 genocide against the Tutsi in Rwanda should be recognized among all youth deeply affected by it. Appropriate policies and programs should be designed and implemented to moderate the effects and strengthen resilience to ensure a peaceful future on an individual, interpersonal, and inter-relational community levels

The “treatment gap” in global mental health reconsidered: sociotherapy for collective trauma in Rwanda

Background: The “treatment gap” (TG) for mental disorders refers to the difference that exists between the number of people who need care and those who receive care. The concept is strongly promoted by the World Health Organization and widely used in the context of low- and middle-income countries. Although accepting the many demonstrable benefits that flow from this approach, it is important to critically reflect on the limitations of the concept of the TG and its implications for building capacity for mental health services in Rwanda. Objective: The article highlights concerns that the evidence base for mental health interventions is not globally valid, and problematizes the preponderance of psychiatric approaches in international guidelines for mental health. Specifically, the risk of medicalization of social problems and the limited way in which “community” has been conceptualized in global mental health discourses are addressed. Rather than being used as a method for increasing economic efficiency (i.e., reducing healthcare costs), “community” should be promoted as a means of harnessing collective strengths and resources to help promote mental well-being. This may be particularly beneficial for contexts, like Rwanda, where community life has been disrupted by collective violence, and the resulting social isolation constitutes an important determinant of mental distress. Conclusions: Moving forward there is a need to consider alternative paradigms where individual distress is understood as a symptom of social distress, which extends beyond the more individually oriented TG paradigm. Sociotherapy, an intervention used in Rwanda over the past 10 years, is presented as an example of how communities of support can be built to promote mental health and psychosocial well-being

Community based sociotherapy for depressive symptomatology of Congolese refugees in Rwanda and Uganda (CoSTAR): a protocol for a cluster randomised controlled trial

Background: Conflict in the Democratic Republic of Congo has led to large numbers of refugees fleeing to Uganda and Rwanda. Refugees experience elevated levels of adverse events and daily stressors, which are associated with common mental health difficulties such as depression. The current cluster randomised controlled trial aims to investigate whether an adapted form of Community-based Sociotherapy (aCBS) is effective and cost-effective in reducing depressive symptomatology experienced by Congolese refugees in Uganda and Rwanda. Methods: A two-arm, single-blind cluster randomised controlled trial (cRCT) will be conducted in Kyangwali settlement, Uganda and Gihembe camp, Rwanda. Sixty-four clusters will be recruited and randomly assigned to either aCBS or Enhanced Care As Usual (ECAU). aCBS, a 15-session group-based intervention, will be facilitated by two people drawn from the refugee communities. The primary outcome measure will be self-reported levels of depressive symptomatology (PHQ-9) at 18-weeks post-randomisation. Secondary outcomes will include levels of mental health difficulties, subjective wellbeing, post-displacement stress, perceived social support, social capital, quality of life, and PTSD symptoms at 18-week and 32-week post-randomisation. Cost effectiveness of aCBS will be measured in terms of health care costs (cost per Disability Adjusted Life Year, DALY) compared to ECAU. A process evaluation will be undertaken to investigate the implementation of aCBS. Conclusion: This cRCT will be the first investigating aCBS for mental health difficulties experienced by refugees and will contribute to knowledge about the use of psychosocial interventions for refugees at a time when levels of forced migration are at a record high. Trial registration: ISRCTN.org identifier: ISRCTN20474555

Suffering of childless women in Bangladesh:The intersection of social identities of gender and class

Research has documented that, around the world, women who are childless against their will suffer from an array of social, economic and emotional difficulties. The causes of this suffering are primarily related to their gender position in society and their gender identity. This paper addresses the impact of class differences on the gender-related suffering of childless women in the socially very hierarchically structured society of Bangladesh. The main method was gathering life histories of illiterate rural poor childless women and educated urban middle-class childless women. The rural childless women experience strong stigma in society, as their identity is devalued due to their inability to produce children. As a result, they suffer from feelings of guilt, role failure, loss of self-esteem, abandonment by the family, social isolation, and impoverishment. In contrast, because of their relatively high socio-economic status and good educational background, urban childless women have more opportunities to avail themselves of alternative social identities and thus avoid social isolation. Despite these differences, both groups of women lead frustrated lives, burdened with a deep sense of guilt for not being able to produce children