The Nature and Psychosocial Consequences of War Rape for Individuals and Communities

Historically the rape of women during war can be traced back to the eleventh century with the occurrence of rape continuing into present day wars. Rape that occurs in the context of war has distinct features, consequences, and implications for research and service providers. This article presents a critical examination of existing literature on the nature and consequences of war rape through a socio-cultural and feminist lens. The paper argues that pre-existing conditions of gender socialization, inequality, body objectification, and eroticism of violence evoke sexualized violence during peace and give rise to rape as a tool during war. The individual and societal consequences of wartime rape are examined through a synthesis of existing literature and considerations for prevention and intervention are presented.


Introduction
Historically the rape of women during war can be traced back to the eleventh century with the occurrence of rape continuing into present day wars (Brownmiller, 1975;Lalumiere, Harris, Quinsey, & Rice, 2005).More recently, the relative unspoken and tragic rape stories of women, have obtained more exposure through media, academic, and political attention (Roque, 2002).Although rape occurs in almost every society, rape that occurs in the context of a war has distinct features, consequences, and implications for interventions.This essay considers war rape in four parts.First, rape as a crime of war will be framed by a brief analysis of the socio-cultural forces that promote the occurrence of rape both during war and peace.Second, the essay will distinctively define the main factors that distinguish war rape from other forms of rape followed by common features between the two.Third, the consequences of war rape will be explored at both an individual and collective level.Finally, given that a woman physically survives this violation, suggestions of how to support a woman post-rape in her country of origin or country of resettlement will be explored.
It should be noted that war rape is not exclusively perpetrated by men against women and girls.During conflict, men and young boys are also victims.With that said, for the purposes of this paper, the focus will be on rape as a gender-based act against women where the greater likelihood of being raped, especially during the time of war, is connected to being female.

Socio-cultural Forces of Rape and Rape as a Tool of War
How does war rape differ from rape during peacetime?According to feminist analyses of sexual violence, rape has roots in the societal male-female power imbalance (MacKinnon, 1994;O'Toole, 2007;Sanday, 2007).The cultural backdrop to rape becomes the expression of domination, oppression, and inequality towards women.Gender socialization of male entitlement over women's bodies perpetuates the cycle of objectification of and violence against women.Rape becomes symptom of a "rape culture" in societies that view women's bodies as property and sexual pleasure as analogous to pain (Buchwald, Fletcher, & Roth, 2005).Thus, rape during peacetime grows into a violent act from the socio-cultural soil of inequality, gender socialization, commodification of women's sexuality, and the eroticism of dominance.Rape during war grows from the same general context, however, the soil has been fertilized with local ethnic, religious, economic and social conflicts that give rise to violent hatred.
Rape is not a random sexual act carried out by individual soldiers, but rather a deliberate military tool to tear apart individuals, families, and communities.McDougall (1998) defined war rape as "a deliberate and strategic decision on the part of combatants to intimidate and destroy 'the enemy' as a whole by raping and enslaving women who are identified as members of the opposition group" (p.4).Although rape is traumatic regardless of when it occurs, during war, rape tends to be of a greater magnitude, frequency, and intention.It is mostly perpetrated by armed or unarmed political/military agents to cause a multitude of consequences and trauma against non-combatant civilians, who are primarily women.However, female combatants have been reported to experience sexual violence (Johnson et al., 2008).Conquering the enemy with the use of rape demonstrates an expression of complete power, a symbolic revenge, and blatant propaganda where "the body of a raped women becomes a ceremonial battlefield, a parade ground for the victor's trooping of the colors" (Brownmiller, 1975, p.38).Given our current understanding of the long-term effects of this type of trauma, it is perhaps one of the most violent and effective tools of war.
Provided that war rape is a continuation of the violence perpetrated against women experienced during times of peace but played out with greater frequency and intensity, then what are the characteristics of war rape that distinguish it from peacetime rape?Five characteristics distinguish war rape from other forms of rape: (a) scale, (b) public occurrence, (c) brutality, (d) slavery, (e) ethnic cleansing and genocidal rape (Kerstiens, 2004).

Scale
The occurrence of rape during wartime is widespread, and massive in scale.Estimates of the rapes that occurred when the Red Army invaded Berlin were as high as 1 000 000 (Grossman, 2006).During World War II, it is argued that 1 900 000 women were raped (Kesic, 2005).In Pakistan, it has been documented that Pakistani soldiers raped more than 200 000 Bengali women (Gottschall, 2004, Tompkins, 1995).In Croatia and Bosnia-Herzegovina, estimates vary between 10 000 to 60 000 (Vlachova & Biason, 2005).Additionally, in the 1994 civil war in Rwanda, 250 000 to 500 000 women and girls survived rape (Vlachova & Biason).
Although these numbers are staggering, it is well documented within the literature that the number of recorded rapes was underestimated due to two factors: the underreporting of rape from victims whom have survived and the lack of statistics on victims whom were murdered or perished due to injuries during or after the assault (Lyth, 2001;Kesic, 2005).Lyth explains, "…because of the shame factor involved, i.e., that the surviving…[women] risk getting stigmatized and ostracized by…[their] society, many victims have chosen to be silent about the crimes that have been committed against them" (p.2).In some cultures, being raped brings tremendous shame and dishonor to not only to the victim but also to her family (Vlachova & Biason, 2005).Due to cultural ostracism and alienation from their families and/or the wider community, many women do not report the rapes that have occurred.Women that were previously virgins can no longer be married, families disown their daughters, and husbands reject their wives.As a result, establishing exact figures of rape victims is difficult and any statistics that are available represent only a small proportion of the actual number of incidents.
Not only is there a high frequency of rape within war, but historical evidence also suggests that the practice of war rape is consistent and frequent across countries (Lalumiere et al., 2005).Since 1980 to present, mass war rapes have occurred in over 45 different countries spanning four continents (Barstow, 2000;Frederick, 2000;Green, 2006;Gottschall, 2004).

Public Occurrence
How, where, and in front of whom the rape is performed are all distinguishable features of war rape.War rape often occurs in the presence of three different audiences: other women (to instill fear), other soldiers (to promote solidarity), and other community members (to show complete suppression).When other women bear witness to the rape, even if they have not been raped themselves, they can speak of power of the invader and the horrific acts that have be inflicted.Often men are also forced to watch their wives, sisters, or daughters being raped, because the rape is intended to torture men as well as the women.Entire families are raped and many family members are killed or tortured trying to protect their loved ones from the horrific acts of sexual violence (Chang, 1997).In some cases, family members are forced to witnessed in silence for shedding a tear may be punished by being permanently blinded (Stepakoff et al., 2006).To increase the pain and widespread terror, soldiers may also force family members to rape or mutilate each other (Bop, 2001).A sixteen-year old girl from the Republic of Congo explains, "At some point my mother and brothers were brought in and forced to watch.When one group [of soldiers] finished, another came in" (Amnesty International, 2004b).
It has been estimated that 90% of rape in war is gang rape thus occurring within the presence of other soldiers (Vlachova & Biason, 2005).The public occurrence of rape tends to increase morale and military camaraderie among the troops (Lyth, 2001;MacKinnon, 1994).One Vietnam veteran explained how most of the military would only rape in front of one another as a form of machoism and male bonding.He stated, "You know it makes them feel good.They show each other what they can do…They won't do it by themselves" (Brownmiller, 1975, p. 107).Another Vietnam veteran explained that the young girls were often hidden and if one was found "she was taken out, raped by six or seven people in front of her family, in front of us, and the villagers" (Tompkins, 1995, p. 845).Likewise, when a Serbian solder involved in the mass rape of Muslim women in Bosnia-Herzegovina was asked why he raped and killed, he responded, "Because I had those guys with me.I had to listen to the orders…" (Stiglmayer, 1994, p. 150).
The consequences for community and family members to know that a woman has been raped leads to long-term cultural, social, and psychological ramifications.Consequently, women are dragged out of their homes to be raped in public both to demoralize a community and to distinguish who has been "tarnished" or "spoiled".Symbolically, when others bear witness to the act or hear the victim's screams, the soldiers have defeated their enemy, "not only physically but more important[ly], psychologically" (Schiessl, 2002, p. 198).In cultures where the sanctity of a woman's sexuality is valued, displaying a woman's dishonor in the public area destroys the entire underlying social order of a community and the core self-worth of the victim.When women, who are often viewed in patriarchal societies as the transmitters of culture, are publicly spoiled, so too, are family, community, and culture destroyed.When describing the extent that women will be socially ostracized by their family and community, Petra Prochazkova (2003) describes "…they'd be better off shooting themselves…a sullied daughter is worse than a dead one to her father" (as cited in Vlachova & Biason, 2005, p.116).
With the availability of modern technology, the public occurrence of rape has increased through broadcasting propaganda to a larger public audience.Rapes are often filmed and shown on television for news, propaganda, and pornographic viewing.In Bosnia-Herzegovina the Serbian forces began a campaign of ethnic propaganda.The footage of rapes with the ethnicity of victims and perpetrators switched were broadcasted to fuel animosity while the sexual pleasure in killing, raping, and torturing women was glorified (MacKinnon, 1994).Due to the use of modern media technology, widespread audiences can suffer the effects of witnessing sexualized violence.

Brutality
Rape that occurs in war has added elements of sadism, xenophobia, and misogyny (MacKinnon, 1994).War becomes the backdrop for legitimizing and exaggerating gender-based hate crimes, resulting in barbaric acts against women.Rape in the context of war takes on such brutality that the woman lying bleeding in front of the perpetrators is no longer a human being but a symbolic body to inflict hatred, violence, and pain upon.In the report, Getting Away with Murder, Mutilation, and Rape: New Testimony from Sierra Leone (Human Rights Watch, 1999), testimonials described an extreme level of brutality.Women were repeatedly and violently gang raped, with each successive rape becoming increasingly more brutal and violent.Often, there is the social pressure for each rapist to "out do" his comrade with more severity than the previous rapist.The report suggests that girls deemed to be young virgins were specifically targeted, the younger ones saved for the higher commanders and those in charge.Accounts of girls as young as eight years of age being raped repeatedly until their ruptured bodies bled to death were described.
Brutality also occurs with the infliction of physical injuries.A woman from Sudan explained how women's and young girl's legs were broken in rape camps so they could be repeatedly raped without the chance of escape (Amnesty International, 2004a).Other acts of ritual sexual torture, such as cutting off women's breasts or gunshots to the genital area, become lifetime reminders of the rape (Amnesty International, 2004b;Vlachova & Biason, 2005).Additionally, the use of different instruments to perform the rape such as bayonets, sharpened sticks to mutilate genitals and sexual organs during the rape is common (Bop, 2001;Kerstiens, 2004).In the Human Rights Watch report on Sierra Leone (1999) one woman describes being sexually assaulted with burning firewood: At least four of them had their guns to our throats and stomachs to make sure we obeyed.The rest of them surrounded us and then a big rebel went to the kitchen of a near-by house and took a piece of burning firewood from the fire.He then squatted down and with his two hands forced it in and out of my vagina one or two times.Then he returned to the fire and got another piece and then a third.I felt as if I was being stabbed inside.

Slavery
During war it is not uncommon for women to be held captive for the purposes of keeping soldiers sexually satisfied and efficiently mass raping as many women and girls as possible.Women and young girls, often still virgins, are held in rape camps where they are tortured, verbally abused, and repeatedly raped.In Nanking, Chang (1997) recounts how young girls were kidnapped and forced into sexual slavery being "tied naked to chairs, beds, or poles as permanent fixtures of rape" (p.51).
The Japanese organized rape camps comprised of "comfort women" to alleviate boredom and sexual aggression in their soldiers.Between 60 000 and 200 000 Korean women were taken and assigned to Japanese soldiers.Recounting the experience, one woman describes, "During the day the women worked hard, usually washing clothes.By night they were forced to provide sex; each woman forced to deal with as many as twenty men a night" (Tompkins, 1995, p. 865).Particularly motivated by racist hierarchy, most women relegated to sexual slavery were non-Japanese women as they were deemed inferior thus deserving of sexual exploitation.In sexual slavery, women's bodies become sexual outlets for soldiers to prove their limitless power over women, their racial, ethnic, religious superiority, and also their loyalty to military or governmental authorities, by following expectations or orders (Stetz, 2007).

Ethnic Cleansing
For the purpose of ethnic cleansing, rape is imposed to women of a specific national, ethnic, religious, or racial group.Rape no longer occurs based on opportunity, rather, women are chosen specifically due to their ethnicity or religion in order to contaminate the enemy group's blood and genes (Farwell, 2004).Political leaders in charge of military forces initiate mass murder and rapes to create a nation comprised of their "dominant" ethnic group.Rape, as an ethnic cleansing military tool, is carried out to prevent births of children belonging to the enemy's ethnicity, through death, sterilization, and psychological harm, while impregnating the enemy with children bearing the offending group's ethnicity.Catherine MacKinnon (1994) poignantly describes genocidal rape, "It is specifically rape under orders…It is rape unto death, rape as massacre, rape to kill and to make the victims wish they were dead…made especially for the perpetrators by knowing that there are no limits on what they can do, by knowing that these women can, and in many instances will, be raped to death" (p.187).
The wars in the former Yugloslavia provide examples of how rape and sexual torture were implemented as a systematic attempt to pursue genocide and ethnic cleansing.By methodically raping Croatian and Bosnian Muslim women, the Serbian army consciously destroyed aspects of Muslim culture: family honor and the sanctity of women's sexuality.Since Bosnian Muslim women are the bearers of culture and a man's dignity relies on women's purity (Vlachova & Biason, 2005), the rapes of Muslim women were calculated acts to dishonor these women, their families, and the men they represented, as part of a larger campaign of extermination.In the Muslim culture, it is common for husbands, fathers, and communities to reject women whom have been raped (Rojnik, Andolsek-Jeras, & Obersnel-Kveder, 1995).After women are raped or suspected of such, often they will never return to their families or villages as their husbands discard them or kill them, their fathers abandon them, and the villagers reject them (Brownmiller, 1975;Meintjes, Pillay & Turshen, 2001).
The forced reproduction of the perpetrator's genes is meant to "ethnically cleanse" the population.Even though children are genetically half of their mother and half of their father, the perception is that the children born of rape are of the rapist's ethnicity is based on cultural practices where children are viewed as belonging to the father.For instance, since Serbian blood was deemed superior, children born of a Muslim mother and Serbian father would be of a Serbian descent (MacKinnon, 1994).As a result, genocidal rape often motivates rape camps where women are repeatedly raped, one man to the next, until death or impregnation occurs.Forced as sexual slaves to remain at the camp until the pregnancy is so far progressed that an abortion could not be completed, the Serbian army could ensure an increase in their ethnicity (Becirbasic & Secic, 2007;Rojnik et al., 1995).In Bosnia, as many as 2 000 women were held in rape camps to force impregnation (Vlachova & Biason, 2005).
During ethnic cleansing and genocide, mass rape of women aims to destroy an entire ethnic group.It aimed at the heart of the culture, the women, to destroy the protectors of their culture (Finley, 2004).Not only are women's lives torn apart with psychological and physical injuries, but their role in society is abolished due to being "spoiled" by rape.Family is the center of community and women are the center of family, so by destroying the women, attackers are one step closer to wiping out their ethnic enemy.
In summary, rape in war is a tactic to: (a) extend violence to women because of their ethnic or social group; (b) promote sexual dominance, hatred, and destruction; (c) intimidate women and destroy their personal identity; (d) exploit women during their vulnerability while demoralizing men for a failure to protect their women; (e) change the demographics of a region by forcibly impregnating women; (f) force a population to flee while instilling terror; (g) serve the group membership and solidarity of the soldiers; (h) provide serial sexual outlets for soldiers through brothel type arrangements; (i) annihilate a cultural group by severing a woman's ties to her community; and (j) implement a strategic military tactic to defeat the enemy in a way that will ensure the effects of victory will be felt long after the initial rape.

Common Threads: War Rape and Rape during Peacetime
In addition to the five distinctive themes of war rape, there are three main similarities between war rape and rape during peacetime.First, wartime rape is an extension of the power imbalances, gender discrimination, and acceptance of violence that exists in societies during peace.Pillay (2001) points out that, "in order for men to carry out atrocities against women, they need a psychological construct that reduces women to property and objectifies women as the other" (p.43).When a woman's body becomes the property of men, misogynistic acts against women are often normalized, excused, and encouraged.For instance, in North American society, women or girls whom have been sexually assaulted or raped are frequently seen as deserving or having "asked for it" by the way they were dressed or how they were behaving (Hargreaves, 2001).Likewise, rape during war becomes a powerful tool with far extending consequences, including disintegration of family and community, due to societal beliefs that victims are to blame for the acts of violence against them.One woman explains, "I keep wondering maybe if I had done something different when I first saw him that it wouldn't have happened...maybe it was my fault.My father always said whatever a man did to the women, she provoked it" (Tompkins, 1995, p. 320).Victim blaming occurs across patriarchal societies regardless of whether or not the rape occurs during peace or war.
Second, rape that occurs in gangs is common not only in war rape but also in sport teams, men's groups, and fraternities across North America (Lefkowitz, 1998;Messner, 2005;Sanday, 2007).Gang attacks against women have been associated with rites of passage, secret rituals, ethnic hatred, male bonding, gang initiation, camaraderie, competition, hypermasculinity, misogynistic talk, and racism (Hargreaves, 2001;Pillay, 2001;O'Toole, 2007;Sanday, 2007).The social pressure on men to prove their masculinity, power, and group membership, appears to be a powerful motivator to rape.
A third element common in war and peacetime sexual assaults is that women often know their perpetrators.According to the 2005 National Crime Victimization Survey, 73% of rapes are perpetrated by family members, friends, partners, and/or acquaintances (Catalano, 2006).In the genocidal rape of Bosnian women, neighbors, acquaintances, and known men were often the perpetrators.Tompkins (1995) recounts one eighteen-year old girl's story where she was confined with other classmates, in order to be raped by Serbian soldiers who were previously her teachers: "In camp he pretended not to recognize me or the other girls who had been his students" (p.867).Another woman described knowing her rapist despite his efforts to conceal his identity, "The Serbs wore black ski masks which covered their faces, but in spite of that, I recognized … our neighbor who was in the Serbian Army; he used to come into the shop where I worked for many years" (Human Rights Watch, 1994).The psychological harm of rape is amplified when women are acquainted with their rapist and there is a greater likelihood of experiencing negative feelings towards all previously trusted men.
These common threads that weave together rape as a tool of war and rape during times of peace highlight the power imbalances, gender discrimination, and acceptance of violence that exists across societies and cultures.Societal belief systems that value, privilege, and give power to men while subordinating women are structures that support gender-based violence against women, whether during war or peace.

Impact of War Rape
Although the consequences of war rape against women may never be completely understood, the wide range of harms need to be explored for purposes of providing appropriate supports and advocating for policies that ensure protection of affected civilians.Provided that a woman or girl survives sexual torture and rape, multiple traumas occur alongside war's path of devastation.Rape victims, at the limit of their coping from having experienced and witnessed a range of life-threatening situations, are further challenged by a lack of resources in a post-conflict society (Yakushko, Watson, & Tompson, 2008)."If we do not have the capacity to prevent war, we have a collective responsibility to better understand and treat its psychiatric, medical, and social consequences" (Hollifield, 2005(Hollifield, , p.1284).In the following section, the consequences of war rape are explored by investigating the impact at an individual and societal level.

Individual Trauma
Women who have been raped in war suffer multiple physical and psychological traumas at an individual level.Physical injuries may include rectal and vaginal tearing and bleeding, throat agitation through forced oral sex, bruising, and broken bones (Tompkins, 1995).Medical consequences can include sexually transmitted infections (e.g., HIV), sexual dysfunction, disturbances with reproduction, carcinoma, vaginal discharge, and chronic infections, as well as more benign but nevertheless debilitating somatic symptoms including back pain, headaches, fatigue, dizziness, fainting, disturbed sleep, chronic pelvic pain, hormone dysfunction, gastrointestinal pain, and eating disorders (Joachim, 2004b;Vlachova & Biason, 2005).Medical conditions are further complicated by the inability to treat symptoms and wounds due to unsanitary conditions, lack of supplies and medications, inappropriate medical facilities, and a refusal of women to disclose rape due to the cultural stigma they might endure (Amnesty International, 2004b).As such, women raped during war are often sentenced to a life with long lasting health problems and many die from injuries, unsafe self-induced abortions, maternal mortality, and suicide (Inter-Agency Standing Committee, 2005; United Nations High Commissioner for Refugees (UNHCR) (UNHCR, 2003).
While there has been a general agreement that gender-based violence during war has mental health impacts (Goldfeld, Mollica, & Pesavento, 1988), there is more recent evidence of a relationship between cumulative trauma and psychiatric morbidity (Mollica, McInness, & Tor, 1998).The psychological consequences of war rape are complex and difficult to categorize due to the core impact of rape, which involves the shattering of a person's sense of safety and trust (Herman, 1997).Mollica and Son (1989) explain that women experience not only a loss of control over their body but also a loss of control in all areas of their lives as "women's illusions of invulnerability, personal safety, and their belief in a safe and fair social world are shattered" (p.365).Consequently, women may experience deep distrust in previous relationships, a fearfulness and withdrawal from others, and a lack of safety within their surroundings and with themselves and others.Disruptions in women's core beliefs, complicated by the cultural taboos around sexuality, make disclosures and support seeking for the acts of violence committed against them nearly impossible.In post-conflict settings, women's distrust is reinforced by becoming reacquainted with their attackers and experiencing continued violence and unsafe conditions in refugee camps and domestic settings (Vlachova & Biason, 2005).Cycles of violence contribute to cycles of trauma (Olweean, 2003) and women's entire lives are disrupted by chronic insecurity and continued victimization causing a "sense of no longer feeling at home in this world, no longer belonging to it" (Joachim, 2004b, p.82).
Psychologically women may experience post-traumatic stress disorder, generalized anxiety, phobias, insomnia, flashbacks, nightmares, grief, and depression (Joachim, 2004b).Women may also show a lack of interest in their environment, complete loss of self-esteem, deep helplessness, and despair.Self-loathing and rejection of one's body often results in self-injurious behaviour and suicidal tendencies.Common psychological defenses in traumatic rape include denial, suppression, depersonalization, distancing, and dissociation (Vlachova & Biason, 2005).As Pappas (2003) observed, "wartime rape turns its victims into 'dissociative containers' who disconnect from humanity and the external world" (p.280).Yet once again, the connection between women's psychological health and rape often remains hidden.If women seek interventions, they are more likely to report physical rather than psychological symptoms, while others suffer in silence and risk serious health consequences (Joachim, 2004b).
It should be noted that the above described defense mechanisms employed by women should be understood in the context of their lives whereby real threats to safety may still exist.In such cases silence and other forms of non-disclosure are survival mechanisms rather than psychological disorders.In post conflict and resettlement situations where physical danger does not exist, safety issues may fall within social spheres that do not acknowledge or accept survivors of war rape.In such cases a woman's psychological trauma may be exacerbated further by her relationship with her community.The shame and humiliation she feels can be reinforced by a society that rejects her, thereby increasing psychological harm and bringing about a multitude of individual losses such as loss of identity, place in society, and self-esteem (Vlachova & Biason, 2005).The collective consequences of this rejection are explored below.

Collective Trauma
Women whom are raped suffer not only the effects of violation at an individual level but also suffer the consequences of war rape at a societal level.Based on interviews with Mozambican women, Sideris (2001) women reported describe that, "when one woman was raped, the whole community was raped" (p.147).A society witnessing wartime rape experiences severe trauma watching atrocities committed against their family and community members.Collectively, the society also enters into shock and grieving as they lose their mothers, sisters, and daughters through community and familial rejection, physical death, or debilitating impacts of psychological and physical wounds.In Common Shock, Kaethe Weingarten (2003) writes that the psychological consequences of witnessing violence can be similar to that of victims, including experiences of shame and psychological distress.In the aftermath of witnessing atrocities such as war rape, communities in shock may not have the means of coping with the reality of events, particularly if events were linked with socio-cultural taboos relating to sexuality (Yohani, 2010).This further isolates victims of war rape as they loose the societal support that can potentially mitigate the effects of their traumas.
Furthermore, trauma and loss as a result of war rape occurs in the context of larger complex emergencies that includes the destruction of political, economic, socio-cultural, and healthcare infrastructure (Toole & Waldman, 1997).Thus women and their families often experience the break-up of community due to forced migration and displacement into camps where education, work, and recovery opportunities are limited.Scholars have noted that the inability of traumatized populations to be economically self-sufficient has a major impact on psychological well-being (Steel, Silove, Phan, & Burnman, 2002).For victims of war rape, entering into a life of extreme poverty and complete dependency places them at risk of further victimization.This includes being forced into other forms of sexual exploitation such as sex trade in order to survive (Joachim, 2004b;Rojnik et al., 1995).For women, the burden of bearing the trauma of war rape can be embedded and lost in the resulting poverty and collective losses experienced by their community.While many victims of war are forced to live in different environments, with different roles, having lost all of their possessions, women who have been raped may also have lost their dignity, reproductive health, sense of basic trust and security, and potentially even their families (Vlachova & Biason, 2005).Thus the individual and collective consequences of war rape often become entwined with broad consequences of war that include cycles of poverty, violence, and trauma.
Unless brought to the forefront, the specific socio-cultural issues and the systemic forces of oppression that give rise to rape as a tool of war becomes lost in post-war recovery activities.The global community's efforts to raise consciousness about mass rape during war are often silenced by the pressing aftermath of war, inability to bring rapists to justice, and cultural taboo reducing survivors' capacity to speak out about the crimes committed against them.It may be impossible to stop war from happening or men from raping, but continued efforts to attend to, understand, and strive towards treatment and prevention are needed.The final section will briefly review current frameworks for service provision, offer considerations for the incorporation of intervention models that address prevention through a feminist lens that aims to rebalance power in survivors, and call to the profession to continue to work towards preventing violence against women.

Intervention and Prevention of War Rape
Models of working with women who have experienced sexualized violence in the context of war are limited.Current psychological interventions focus primary on culturally sensitive counselling with refugees in countries of resettlement (Bemak, 2002;Bemak, Chung, & Bornemann, 1996), working with PTSD or complex traumatization (Butollo 1998 as cited in Joachim, 2004a;Chu, 1998;Courtois, 1999;Herman, 1997;Mollica & Son, 1989;Wilson, Friedman, & Lindy, 2004;van der Kolk, van der Hart, & Burbridge, 1995), paradigms that offer somatic approaches to healing from trauma (Ogden, Minton, & Pain, 2006;Rothschild, 2000;Solomon & Siegel, 2003), and frameworks for working with survivors of war torture and trauma (Hanscom, 2001;Van Dijk, Schoutrop, & Spinhoven, 2003;Weston, 2001).In refugee camps and post-conflict areas, some scholars have addressed the necessary considerations for reducing violence and offering services (Shanks & Schull, 2000).Likewise the UNHCR (2003) has offered guidelines for prevention and response to sexual and gender based violence against refugees and internally displaced persons (IDPs).
While great strides have been made to bring more visibility to the issue of war rape, continued attention, understanding, and interventions are needed.After reviewing the literature on war rape from a feminist and socio-cultural lens, it is clear that the individual and collective impact of disempowerment through gender inequality, socialization, and body objectification cannot be separated from any discussion on working with female survivors.Central to this understanding is the need for women's participation at all levels of their healing, including how to best create and offer support services.This means the development of supports, interventions, and treatment frameworks need to be grounded in survivors' self-assessments while balancing the socio-cultural barriers women face in speaking about their trauma.Keeping these two frames in mind can serve as a guide to prevent the potential to disempower, sensationalize, and construct dominant oppressive narratives when exploring stories about sexual assault (Alcroft & Gray, 1993), and recognize the sensitive nature of eliciting stories about sexual violence (Campbell, 2002;Campbell, Adams, Wasco, Ahrens, & Sefl, 2009;Newman & Kaloupek, 2004;Newman, Risch, & Kassam-Adams, 2006;Rosenbaum & Langhinrichsen-Rohling, 2006).
The centrality of women's voices should be the primary guide for models of treatment.Professionals with experience working with survivors of sexual violence who extend their work to women who have experienced war rape need to reflect deeply upon the contexts within which survivors are living and the nature of services being offered.Given the limited work in this area, professionals could contribute to the field by sharing their experiences of successful, client-guided services.In countries of resettlement, refugee women bring with them the range of pre-migration atrocities (Berman, Girón, & Marroquin, 2006) and the layers of trauma need to be understood socially, politically, historically, culturally, psychologically, and physically, based on each survivor's experience.Based on the authors' experience of offering services to survivors of war rape in post-migration contexts, relevant considerations in developing interventions include: (1) providing services that are culturally sensitive to the phenomenological reality of the survivor; (2) understanding that trauma work is occurring within the instability of early resettlement, post-migration stressors, and ongoing collective and individual consequences of trauma including war rape; (3) addressing gender and culture in service provision; (4) ensuring discretion and sensitivity to stigmatization while recognizing survivors are resilient women who are capable of informing services (Yohani & Hagen, in press).Overall, in recognizing the limited information available for working with survivors of war rape, exploring ways to facilitate speaking out by survivors and service providers has the potential to build collaborative models of care informed by experience, theory, and practice.
While it is necessary to understand the treatment of sexualized violence, the underlying issue of preventing violence against women during war remains.What drives men to rape women in the first place?After a historical and ethnographic review, Lalumiere and colleagues (2005) found that rape is more common when men are considered superior to women, there are no repercussions to their actions, and hateful attitudes towards women exist.Likewise, Madden & Sokol (1994) suggest that "programs directed toward individuals are band-aids that do not address the systemic, societal causes of violence and discrimination against women" (p.24).Men continue to rape women in all societies, but in war, the crimes are fueled by ethnic, religious, or political hatred escalating to an indescribable level of violence.Although rape is devastating irregardless of when it occurs, during warfare, rape becomes a strategic military tactic, an order, a carefully planned attack, that wages a sexual war against women's minds, bodies, and spirits resulting in complete destruction or a lifetime of damage to a woman's relationship with herself, others, and the world.After nine centuries of rape during war, it was not until 1998 that rape was first prosecuted as a crime of war.While society has made great strides in bringing more visibility to the issue of war rape, it can be argued that much more needs to be done to ensure women have (a) equal access to economic, social, and political power, (b) legal recourse so perpetrators of rape are brought to justice, and (c) tools to deconstruct masculinity and gender inequality in the military and community.

Conclusion
The complex web of structures that give rise to violence against women occurs across societies.The magnitude, extensiveness, and consequences of war rape are more complex yet.The days of war where military battles were waged between fighting forces, with hopes of limited civilian casualties, have been replaced with wars that target, terrorize, and sexually victimize civilians, especially women and children.In World War I, civilian causalities were minimized and about eight military and paramilitary forces were killed to every one civilian (Barstow, 2000).Since 1945, the ratio has been reversed and wars now kill eight civilians to every one military personnel (Barstow).Wars often target women and their bodies through sexual violence to seize, control, and destroy not only the woman but also the families, communities, and culture she represents.
We cannot wait for days without war, a world where men stop abusing women, where "men decide not to rape" (Marcus, 1992, p. 400).There are 16 million refugees and asylum seekers and 26 million civilians are currently displaced (UNHCR, 2009), of which at least 70-80% are women and children (Internal Displacement Monitoring Center, 2005).Strict immigration/refugee laws and political encampment policies, combined with barriers brought on by physical and psychological trauma and lack of identification, limit women's access to resources and ability to find necessary support or safe refuge.Vlachova and Biason (2005) explain that many women are "caught in limbo" unable to return to their country of origin, and yet not eligible for a third country of resettlement.Internally displaced persons or IDPs have not crossed international borders and do not receive the protection, assistance, or rights as refugees.Widespread sexual violence does not end when the war ends, rather the millions of refugee and displaced women live without protection from ongoing sexual coercion, violence, and exploitation in refugee camps and post-conflict societies.As the refugee and IDP population increases, the international community is challenged to increase our understanding of the political and power structures that promote cycles of violence against women.