BIDIBIDI CAMP, Uganda – Grace sits staring vacantly ahead, her hands tightly clasped in her lap. She is 16 years old but has a tiny frame that makes her look no older than 13. Underneath her checkered school dress, a small bump sticks out. In four months’ time, she is due to give birth to her stepfather’s child. He raped her after soldiers attacked her village in South Sudan and her mother ran away to escape the shooting.
“I wanted to starve to death,” she whispers, speaking through a translator.
Sexual violence is an everyday threat to women and girls in South Sudan, where civil war broke out in 2013. There are cases, like Grace’s, involving attackers known to the victim, as well as a torrent of rape allegations against government and rebel troops.
In December, Yasmin Sooka, chair of the Commission on Human Rights in South Sudan, said the scale of sexual violence in the country had reached “crisis proportions” and described the levels of gang rape as “epic.” In addition, she said, widespread stigma leads to underreporting of sexual violence.
In Uganda’s Bidibidi refugee camp, where Grace now lives, mental health workers are attempting to fight that stigma and help survivors heal from trauma. Opened in August 2016, 25 miles (40km) from the border with South Sudan, Bidibidi is one of the world’s largest refugee camps. It hosts more than 272,000 South Sudanese refugees, 86 percent of whom are women and children, according to UNHCR.
The U.N.’s refugee agency has documented 570 cases of sexual or gender-based violence perpetrated on refugees living in the camp. Some of those incidents took place in South Sudan – a recent U.N. survey of internally displaced people living in camps in Juba, South Sudan’s capital, found around 70 percent of women had been raped since the conflict erupted, with 78 percent forced to watch someone else being sexually violated. But there are also women who have been assaulted inside Bidibidi, says the UNHCR. With limited police presence in the camp, women are particularly vulnerable to attack when collecting firework. And without more resources, health experts say, many of the violence survivors in the camp will never get the help they need to cope with the aftermath of their attack.
For now, Grace is being spared that fate. She is one of 36 victims of sexual violence receiving cognitive behavioral therapy from Transcultural Psychosocial Organization (TPO), the sole NGO providing specialist psychosocial services to the camp’s population.
“Some of the girls were raped by soldiers as they tried to escape the country,” and are now pregnant, says TPO social worker Shifah Uzamukunda. “We encourage them to share their experiences, and teach them about trauma.” The organization also provides therapeutic activities like dancing, drama and singing.
At one of four women’s centers in Bidibidi run by the International Rescue Committee (IRC), around 80 women sit on straw mats, chatting. In a corner, a group of women are embroidering cotton sheets, while outside, another group cooks mandazi, an East African fried bread, and a third group builds fuel-efficient stoves, all of which the women will sell within the camp.
About a quarter of the women are rape survivors and have access to one-on-one counselling.
“At first it was difficult to get people to talk about sexual violence,” says Zuleika Munduria, a program officer for the IRC. “They would ask, ‘I want to know my [HIV] status; I don’t trust my husband.’ But we would find out they had been raped and that was why they wanted to have an HIV test.” However, she says they slowly started gaining the confidence to speak.
The women practice relaxation and meditation techniques, learn life skills such as baking and sewing, and take part in group counseling where they are encouraged to talk openly about what they have suffered. Today, the women are vocal about their struggles.
“I [was suffering from] psychological torture when I came here, but now those thoughts are gone,” says one woman, who asked not to be named.
Another woman, who also asked to remain anonymous, says, “I’m now free. I call this place Help.”
Beyond sexual violence, countless South Sudanese have witnessed family, friends and neighbors lined up and killed, and had their homes looted and torched. In February, the U.N. announced that the number of South Sudanese refugees fleeing the war had reached 1.5 million.
Of the 724,000 South Sudanese refugees in Uganda, UNICEF estimates that 64 percent are children and says that “most refugee children from South Sudan are experiencing some form of psychosocial distress,” according to UNICEF.
But mental health services are in short supply, as the emergency response is already vastly stretched to provide basic water, food and medical needs. UNICEF says only 36 percent of the $251 million requested by the United Nations to cope with the South Sudanese refugee situation in Uganda has been received. “The South Sudan refugee emergency has been chronically and severely underfunded, and as a result provision of essential services on the rapidly growing refugee population of Bidibidi and other settlements remains a challenge,” says Jens Hessemann, senior field coordinator for UNHCR Uganda.
And without help now, says Dorothy Namara, a clinical psychologist for TPO working in Bidibidi camp, many survivors of sexual violence will carry their trauma with them for the rest of their lives.
“Not everyone knows they are suffering,” she says. “It imprints on children’s memories for a long time and can lead to personality change. It is not something that just goes away.”