As it is the case for female victims of sexual violence, male victims suffer from various types of physical pain, which can be related to total or partial castration, genital infections, ruptures of the rectum, etc. However, because they are too ashamed to ask for help, many victims prefer to bear the suffering on their own, with sometimes fatal consequences. According to the medical staff I have met in various places in Eastern DRC and Burundi, male survivors do not seek medical support unless they really have no other choice and have severe health problems like festering wounds or serious hemorrhage (see also Gettleman 2009). In addition, many of them face physical sequels that further add to their shame and further undermine their masculinity in the eyes of their relatives, such as physical impotence or urinary incontinence (Refugee Law Project 2014, 8). Because they are likely to demonstrate that survivors are neither powerful nor in control anymore, even the most serious of these physical sequels often remain unreported and, therefore, uncured. Male survivors I spoke with were very reluctant to detail their physical pain, enduring it on their own:
I am still in pain, yes, some parts of me still hurt. But I don’t want to… I can’t really speak about it. So I have to live with it, and pray that it goes away. (Jean-Paul 2009, interview)
Many were adamant that they could not mention their physical pain to anyone, least of all to their relatives:
I hurt, a lot. I cannot eat what I want, and even sitting is painful. But it won’t change anything to speak about it. I don’t want my family to know that I am suffering. This isn’t proper. (Jacques 2013, interview)
The expectation that men will bear physical pain without complaining plays an important role in the low level of reporting. As a consequence, the survivors’ unspeakable physical and often chronic pain locks them in solitude and deprives them of much needed support (Misra 2015, 170).
But even when they report the assault, the lack of training and of preparation of medical staff and health care professionals regarding sexual violence against men can put survivors in further danger. Physical symptoms are frequently overlooked, and they are thus often not addressed in time. Even in regions where sexual violence against men is widespread, such as in the Great Lakes region of Africa, there seems to be very little understanding that men can be victims of that type of violence, and more particularly that they can be raped. In a rural hospital of South Kivu, for instance, one of the doctors I spoke to did not really understand what I meant when I was asking him about sexual violence against men, and thought that I was speaking only about forced incest, or of cases where men have to watch other female family members being raped. Surprisingly in a region where the prevalence of male sexual victimization is so high, he said he had not heard about men being raped or castrated (FOMULAC Hospital 2012, interview). This oversight, combined with the shame felt by survivors, leads them to underestimate the consequences of the violence they have been victims of, and to requalify sexual violence into types of violence that medical staff is likely to understand and be knowledgeable on. As a consequence, both survivors and sometimes also health care professionals tend to use more abstract categories for describing sexual abuse, such as beatings, which veil its sexual nature and overlook its deep impact on survivors’ gender identities and social status. By symbolically stripping episodes of sexual violence from their sexual characteristics, the medical staff thus overlooks the fact that the gendered nature of these acts is likely to profoundly affect the survivors’ capacities for recovery.
What is more, and as we will further explore in chapter 6, most programs fighting sexual violence and offering support to survivors set up by international or national organizations in conflict areas specifically target female victims of sexual violence. Men are sometimes not even accepted in these facilities, thus impeding their access to adequate and indispensable medical care (Dumas 2011). Aside from these humanitarian support programs, medical treatment and support is sometimes available, mainly in large cities like, for instance, in Bukavu in South Kivu, where the Panzi hospital has specialized in treating victims of sexual violence. But because many survivors come from deprived communities, even when they live close to a large city they cannot afford to spend money on medical expenses. The costs of a reconstructive surgery, regardless of its necessity, are prohibitive for them. In addition, spending time in a hospital would often mean losing their job, which they cannot afford because nobody would then be able to cover their daily expenses. As a consequence, some male survivors who can afford it try to cope with the physical pain by taking painkillers, which of course are far from being sufficient.
Male survivors of sexual violence also face an intense mental and psychological suffering, which is in many ways similar to what female survivors of sexual violence experience. Commonly reported symptoms include loss of appetite and of sleep, exhaustion, anxiety and nightmares, all consistent with a post-traumatic stress disorder syndrome (Christian et al. 2011, 236; Loncar, Henigsberg and Hrabac 2010). A lot of male survivors also experience extreme mental fatigue, haziness, disinterest and withdrawaclass="underline" “Just thinking about what happened to me makes me tired” (Vandecasteele 2011). Suicidal thoughts and self-disgust are also common. Jean-Claude, a Burundian who was abandoned by his wife and children when they heard about what had happened to him, is in extreme distress:
I’d rather be dead. They should have killed me. I don’t have a life anymore. (Jean-Claude 2011, interview)
Léonard, a Congolese man who has now been living alone for several years, expresses feelings of loss and confusion:
They did things that I cannot speak about. I cannot… I still cannot understand what happened, how that could happen. What I know is that I am not the person I was before it happened. I am here, but at the same time it is like I am not here, I don’t want to be here. (Léonard 2014, interview)
Similar testimonies have been collected elsewhere, notably among Bosnian survivors of wartime sexual violence: “Later when I play it all in my mind, if it were to happen again I’d rather be killed than to go through that again. (…) I was the happiest when I was taken out to be shot” (male survivor interviewed in Silent Scream/Nečujni Krik documentary).
Some studies claim that male survivors of rape display higher levels of anxiety and hostility symptoms than female survivors, especially among former child soldiers (see, for instance, Betancourt et al. 2011). Similar findings, pointing at higher post-traumatic stress disorder rates, and higher suicidal tendencies among male survivors, have also been described in the case of former combatants and rape survivors in Liberia (Johnson et al. 2008). However, such results have to be interpreted with a lot of caution since male survivors are known to be even less likely than female survivors to report episodes of sexual violence, either to relatives or to medical staff. Thus, the male survivors under scrutiny in these studies are more likely to be those who have been through the most horrendous and destructive episodes of violence, and perhaps displaying higher levels of depression, trauma, mental illness and anxiety. Considering also the additional public shame that those who report these acts have to face, it is also probable that reporting, if not accompanied by serious psychological support, constitutes a further source of anxiety for male survivors.