Dr. Denis Mukwege opened his hospital because he wanted to bring down maternal mortality in the Democratic Republic of the Congo. But the first case he saw was a survivor of gang rape.
Mukwege, a gynecological surgeon, says he remembers the case clearly. "It was a woman who had been raped by many people, and her genitals were torn. She arrived with very, very serious injuries."
After that first operation in September of 1999, he saw more and more victims of extreme sexual violence come through Panzi Hospital's doors. He says his team operated on 45 women in the first three months.
"I had the impression that this was an enormous number, because I'd been in the region for a few years, and I'd never seen this before," he says. "It wasn't until 2000 that I understood that this was normal, and I began to call on the international community."
Today, Mukwege, 62, is renowned as a pioneer in the field of gynecological surgery, and there is growing awareness worldwide that rape is used as a weapon of war in conflict.
Sexual Violence in DRC
Since 1999, Panzi, located in Bukavu, the capital of the eastern province of South Kivu, has treated more than 85,000 girls and women with complex gynecological injuries, 60 percent of whom are survivors of sexualized violence.
Data on sexual violence in the DRC is limited, as the majority of rapes are not reported. But estimates show that, in 2011, between 1.69 million and 1.80 million women said they had been raped during their lifetimes, and more than three million said they had been abused by a partner.
Dozens of armed groups operate in eastern Congo and many of them, including the Congolese armed forces, have perpetrated acts of sexual violence, according to Amnesty International.
The victims are often harmed with machetes and other weapons. The perpetrators will target anyone: from girls as young as two to women older than 80. Many victims end up suffering health consequences, such as vesicovaginal fistula (a deep tear between the bladder and vagina that results in involuntary urine leaking into the vagina), HIV infection, and other sexually transmitted diseases.
During the early 2000s, Mukwege's patients mainly came from conflict zones such as the isolated and mineral-rich area of Shabunda, and from Mwenga, an area on the western shore of Lake Kivu controlled by Mai-Mai and Kalehe militia groups.
These days, most of his patients come from the center of the country, such as the Kasai region, where ethnic conflicts and tensions between the government and local leaders have recently boiled over, leaving thousands dead.
Health Workers in the Firing Line
Not everyone sees Mukwege as a healer. On October 25th, 2012, he and his family were brutally attacked at his home in an attempted murder. Five men armed with pistols and AK-47s held his two daughters hostage, and by a fraction of a second he narrowly escaped being shot by throwing himself on the ground. His trusted bodyguard was killed. The family fled to Belgium, but he returned in 2013.
The motivation behind the attack is still unknown. Weeks earlier, at a speech at the United Nations, Mukwege had criticized the government of DRC for the deeply rooted conflict and called for those responsible to be brought to justice. New York Times columnist Nicholas Kristof has suggested that Mukwege was targeted "because of a strong speech he gave at the U.N. ... denouncing mass rape in Congo and the impunity for it."
But the doctor refuses to be scared into silence, and he frequently raises the issue of health workers' safety in conflict when he travels.
"Today we see this tactic threatening facilities in Syria and in Iraq," he says. "I think that's a very bad sign for the world today. The sick must be respected."
Five Steps to Healing
Mukwege has earned a slew of international plaudits, including the United Nations Prize in the Field of Human Rights (2008), the Sakharov Prize for Freedom of Thought from the European Parliament (2014), and the Right Livelihood Award (2013), often referred to as the alternative Nobel Prize for human rights. He was named one of Time magazine's 100 Most Influential People in 2016, and has been rumored to be in the running for the Nobel Peace Prize a number of times.
Today, he lives two lives: One is based at Panzi, where he is still chief surgeon, and which sees nine to 15 new patients per day. In his other life, he is an international advocate for survivors of gender-based violence, flying across the United States and Europe to promote his cause, which has him rubbing shoulders with the likes of Hillary Clinton, Ban Ki-moon, and Emmanuel Macron.
He says he sees his international campaign work as vital to the healing process for survivors in DRC.
"After treating 10,000 victims of sexual violence, including children who had been abused, I realized the problem wouldn't be solved inside the operating theater," he says. "I needed to go beyond the surgeries."
Through the Panzi Hospital, its U.S.-based charitable foundation and the Dr. Denis Mukwege Foundation in the Netherlands, Mukwege promotes a five-step "holistic" healing process which, he says, "turns victims into survivors."
After the first step, which is the surgery to repair physical trauma, patients are given counseling to help them overcome the psychological effects of rape.
"If you are physically well, but not mentally well, you can't be reintegrated back into your community," Mukwege says.
Reintegration also means finding new employment for women, who are often unable to return to their communities due to ongoing violence or the stigma associated with being a survivor. So the third step is to give women training and education to allow them to become economically independent.
As a fourth step, the hospital collects legal evidence to allow survivors to pursue justice for the crimes committed against them. Panzi's staff hope that, one day, when the DRC or an international court holds an inquiry into rape as a weapon of war, they will be able to present the evidence they have amassed over the years to secure a just resolution for the millions of women who have been raped.
Finally, there is the advocacy work that keeps Mukwege so busy and helps keep international eyes on a country torn apart by conflict and facing an uncertain future. The DRC's president, Joseph Kabila, was supposed to step down in December of 2016, but has remained in power and postponed elections until at least 2019, causing widespread unrest.
"When war turns on women and children, I think the world must do more for them," he says.
Most recently, Mukwege has been campaigning to close the gap between rich and poor countries when it comes to gynecological health. He wants to see fistula wiped out on a global scale. And he is still passionate about bringing down maternal mortality.
"Maternal mortality has become rare in the Global North," he says. "And doctors [there] can repair fistula, so it doesn't exist. Our global objective has to be to end that difference."
This article originally appeared on Women & Girls. You can find the original here. For more coverage and community engagement focused on women & girls in the developing world, you can sign up to the Women & Girls email list.