Dressed in a red and green dress, Elise* sits clutching her friend’s hand as she recounts her story to a social worker at the Isange One-Stop Centre.
Signs such as “Break the silence when you see gender-based violence” and “I’m here to work, not for sex” adorn the small centre, which is situated next to the bustling maternity ward inside Kacyiru district hospital, not far from Kigali city centre.
Fighting back tears and taking deep breaths, 18-year-old Elise tells the social worker: “My friend locked me in his bedroom and raped me. I’m now pregnant.”
Elise has come to the centre for counselling, medical care and, if she chooses, legal aid. Isange, which means “You are among yours”, is a holistic hub for survivors of gender-based violence where all services are provided under one roof and are free of charge.
The centre hosts social workers, psychologists, doctors and investigators from the Rwanda Investigation Bureau. If it’s not safe for survivors to return home, there’s also a place where they can stay.
The centre is run by three Rwandan ministries – health, justice, and gender and family promotion – along with the National Police. It initially began as a pilot in 2009 but the model has since expanded across the country to 44 sites – one centre in every district hospital.
As Rwanda strives to overcome its legacy of the 1994 genocide, where rape and HIV were used as a weapon of war, gender-based violence continues to be a persistent problem. According to UN Women, about a third of women and girls aged between 15 and 49 in Rwanda will experience sexual or physical violence from a partner. At least 41% of women experience physical violence by the age of 15.
But the country has taken steps to address the problem. In 2008, parliament passed a law, which, along with defining violence cases and outlining sentences, created an obligation for all citizens to report violence. Over the years that followed, gender-based violence committees were established in every community across the country. The purpose of the committees is to raise awareness about violence, report perpetrators to authorities and refer survivors to services like the Isange centre.
“We’ve come a long way but gender-based violence is still there,” says Daphrose Nyirasafari, a reproductive health specialist at the UN population fund (UNFPA) Rwanda.
The centre in Kigali receives between 10 to 12 victims of violence a day. Of those, 28% are survivors of intimate partner violence and the rest have suffered sexual assault, says Dr Daniel Nyamwasa, commissioner of police at Kacyiru.
“Alcohol and anger is a big problem. It’s fuelling violence,” he says.
However, Dr Jenevieve Mannell, a lecturer in global health at University College London, whose research focuses on preventing violence against women and girls in Rwanda, says the larger issue is the failure to view the issue through the lens of gender inequality.
“Communities say alcohol is a problem but some men I’ve spoken to said the problem with alcohol is that because women had gained more empowerment, [the men] were going out to bars and that was perpetuating violence. If you don’t have a gender lens, it gets turned around as a woman’s fault,” she says.
“Taking a gender equality approach is really needed in Rwanda because without that, you end up with solutions that blame women for violence and that’s really dangerous.”
Back at the centre, the children’s therapy room is decorated with brightly coloured cartoons and a pile of dolls resting on the toy table. About 16% of sexual violence survivors at the centre are children under five.
“When children come for help they are so traumatised that they tear the cartoons off the wall,” Dr Nyamwasa says.
The centres are well-known across the country thanks to community health workers, village leaders and the use of media to spread the message. There’s also a toll-free number people can call to request help 24/7.
Recent research on the one stop centre found that legal support led to 47% of perpetrators being arrested and 31% of those prosecuted. The study also found that psychotherapy reconciled 57% of couples where intimate partner violence had occurred.
Elise was raped a week ago so it’s too late for her to take post-exposure prophylaxis to prevent HIV infection – a key concern at the centre. She will still undergo a vaginal exam and be tested for sexually transmitted infections.
She will also be able to have the abortion she is requesting. Rwanda’s recently changed abortion law – though still highly restrictive – no longer requires a judge’s approval for the procedure in cases of rape, forced marriage, incest and when the life of the mother or baby is in danger.
But if she decides to pursue legal action against her rapist, it may be a long road ahead. While married women have numerous protections under the law, there are a lot fewer for women who are unmarried, a sign Rwanda has a long way to go to fight gender inequality.
“Under the law Elise can get the abortion she is here for but it’s her friend that assaulted her – that implies it’s intimate partner violence, which could be hard to prove,” says Dr Nyamwasa.
*Name changed to protect identity