The story of displaced civilians in eastern Democratic Republic of Congo (DRC) is old and painful. Yet one continual thread in that tale is the scourge of rape. When displacement and rape combine, the burden on humanity gets heavier, as we saw recently in Goma.

Here, survival for the hundreds of internally displaced people (IDP) is a daily struggle. They have to deal with the dwindling rations, unpredictable weather elements and diseases, and the uncertain security. It is worse for women, many of whom are living with horrid tales of sexual violence.

Every day, about 70 women, all survivors of sexual assault present themselves at the temporary structures set up by the MSF in the Lushagala, Bulengo, Elohim, Shabindu, Rusayo and Kanyaruchinya sites. 

Every day, the same group has to also deal with the precarious living conditions in the camps, in which access to food and other basic necessities is limited. That puts them at the risk of becoming exposed to sexual violence. Many of them say they went there fleeing sexual violence, only to be followed by the same nightmare.

Read: 15 DR Congo soldiers tried for rape

“The only way we can find food is to go to the fields, but women like me who have been attacked don’t want to go back and are totally dependent on humanitarian aid,” says a 20-year-old woman. She says she lives in fear after being sexually assaulted by a gunman in Lushagala as she tended to her bean garden in the camp.

From the outset, it is clear that humanitarian actors, donors, and Congolese authorities must urgently step up their efforts to improve the living conditions of women, and hence reduce the risk of aggression.

For now, however, the situation for women, especially, in the camps is dire. Often the lone providers for their families, many women have no choice but to leave the camp in search of wood and food, exposing themselves to the risk of violence, particularly sexual violence. 

During the month of July alone, 1,500 female survivors of sexual violence sought care from MSF teams at Rusayo, Shabindu, and Elohim camps— more than twice as many than in May, according to data provided by Rasmane Kabore, the MSF Head of Mission here. 

“About 80 percent of these survivors were treated within 72 hours of being assaulted, which illustrates the scale of the emergency. 

“The sooner they come forward, the sooner we can offer them emergency care to prevent unwanted pregnancies, sexually transmitted diseases - especially HIV - and other complications. In addition, we are observing that assaults are becoming increasingly violent, with associated physical injuries, and a growing number of women are being raped more than once” adds Rasmane. 

Read: DRC to rein in officials after sexual abuse scandal

Most survivors are assaulted outside the camps while searching for firewood or food. Yet they can’t stop heading out unless they starve.

However, in recent weeks, MSF teams observed an increase in cases of sexual assault in the camps where MSF operates, by about 15 percent. Families are sleeping in tents that do not close, and the lack of access to basic services is forcing some women to resort to transactional sex, making them more vulnerable to exploitation and abuse.

“After I was attacked, friends of my husband advised him to abandon me, and now I live alone with my four children,” explains a 23-year-old pregnant woman living in Rusayo camp. 

Rape and other forms of sexual violence are dangerous not just for the physical wellbeing of the victims but their mental status as well. How fast they can be helped when in distress, however, depends on the work of community mobilisers, whom we learnt are essential to fight against stigmatisation. 

“I listened to a community mobiliser talking on a megaphone outside my house. He said to go to Tumaini [Swahili for hope] clinic, where a flower was drawn if you had been subjected to violence,” adds a 20-year-old woman living in Lushagala. 

Rebecca Kihiu, MSF gender-based violence expert says sexual violence often requires urgent attention but the fact that women also come with other forms of health problems means aid workers cannot respond to one and ignore the other.

“Women in the camps face a multitude of health problems, and while focusing on emergency treatment for sexual violence is a priority, we must not neglect other health services for women,” Kihiu explained. 

For the tens of women who show up for help, MSF teams first give medical and psychological care, then they get various methods of contraception, treated for sexually transmitted diseases, and help to safely terminate pregnancy. 

Read: How mental health of mothers is affecting generations

In the Kanyaruchinya health centre, MSF also supports the obstetric and neonatal care department, where about ten women receive a medical childbirth every day. 

“To prevent the worst, I went to MSF to look for contraception so that I wouldn’t get pregnant if I was attacked. I could not feed any more children,” says a woman treated at the MSF clinic in Rusayo. 

“In addition to the medical consequences, the women we see suffer from emotional problems, anxiety, depression, and insomnia,” says Jerlace Mulekya, mental health supervisor at the MSF clinic in Lushagala.

“We also accompany them to prevent their psychological state from worsening at a time when they need to remain particularly strong to face up to their daily difficulties.” 

Despite an improvement in access to water, latrines, and other basic services in some camps in recent months, women continue to live in poor hygiene conditions. 

“We are a medical humanitarian organisation, and other stakeholders, as well as the Congolese authorities, must do more to prevent violence against women, ensure their protection in the camps, and put an end to impunity for the perpetrators of these crimes,” says Kabore. 

“Donors must continue to increase their funding and humanitarian aid agencies must continue their efforts to improve conditions for women. This includes improving access to food, distributing fuels and cooking equipment, and setting up social and legal protection services so that women feel safe. To reintegrate survivors into society, we must implement a holistic approach based on their needs and preferences, as well as substantial economic support.”

The authors are aid workers for medical charity group Doctors Without Borders (MSF). They recently returned from assignment in Goma, eastern Democratic Republic of Congo.