S3G Phase II 1.1	Focus on DRC, specifically the provinces of North and South-Kivu History of Violence, Conflict and Instability
For three decades the eastern part of the Democratic Republic of Congo (DRC) has been immersed in cycles of violence, which have had a brutal effect on the social fabric. In Eastern Congo alone, more than 100 non-state armed groups including rebels, local armies and bandits are operating in relative freedom in the absence of strong state authorities. Government institutions are in many areas incapable of providing adequate services to communities nor able to mediate (inter-) community tensions. The efforts of the international community, including the MONUSCO mission to contribute to peace, stability and justice have largely been insufficient. As a result, the twenty million citizens of the Kivu provinces of DRC have been plagued by human rights violations including (gang) rape, abduction for sexual slavery, forced participation of family members in rape, and other atrocities against men and women. The high prevalence of violence together with the fragile political system and insecurity has severely impacted the DRC’s health system as well as legal system. The weak health system is further burdened by the elevated caseloads of survivors of (S)GBV suffering from both severe, immediate medical and psychological trauma and by high death tolls. Because of a lack of adequate services, survivors are often left with long-term traumatic consequences. The high prevalence of (S)GBV also results in serious family disruption and threatens community cohesion and solidarity. Many investments have been made in recent years to strengthen the response of the judiciary and national Congolese police (PNC) to these cases, but there are still serious challenges in terms of quality and access to legal services. Furthermore, corruption is common in the legal system and many cases are not followed through (“classement sans suite”), which discourages people to institute a case. By consequence, many people prefer to settle a crime or conflict outside the official system (“arrangements à l'amiable”). To cope with these failures of government structures, access to treatment and holistic support services for (S)GBV survivors is important, followed by full social inclusion of (S)GBV survivors into the community. Addressing the widespread impunity of the perpetrators of (S)GBV is crucial as demand for legal actions has shown an increase in the S3G –first phase project. This project aims to respond to three dimensions of conflict as defined by the Embassy of the Kingdom of the Netherlands (EKN) Kigali: the rapidly growing population related to lack of access to contraceptives; poverty related to insecurity; gender inequalities related to violence.
Project Target Areas: (S) GBV in South Kivu and North Kivu (Eastern DRC)
The project’s target provinces, North Kivu and South Kivu, remain among the most impoverished provinces of DRC with a poverty rate respectively of 72.9% and 84.7%. Young people between 10-24 years, and particularly young women, belong to the most vulnerable populations within these conflict-affected areas of the DRC. In addition, many people from rural areas keep moving to urban (slum) areas. According to MICS 3 (2017-2018), 60.8% of the rural population of women of childbearing age has changed their place of residence in North Kivu while in South Kivu this rate is 55%. Bukavu and Goma have large mobile populations of families of military and police staff who are impoverished and often living isolated from settled populations. Police and military tend to be underpaid/paid with delay and this situation often leads to reprehensible situations of the latter nearby the populations.
In 2018, MONUSCO documented 1,049 cases of sexual violence by uniformed men against 605 women, 436 girls, 4 men and 4 boys, the majority in North Kivu and South Kivu Provinces. This situation apparently seems to have become worse according to the publication of a report of the Joint UN Human Rights Office (BCNUDH), July 2022, which mentions a sharp increase of adult SGBV survivors case reports since early 2022. The reports that this office receives, are mostly related to attacks by armed groups. However, (S)GBV is not limited to direct conflict, it is an increasingly common feature of civilian life in conflict-affected areas and remains under-reported. Therefore, both military tribunals (North-Kivu) and civilian tribunals (South-Kivu) need to be strengthened. Underreporting and impunity of (S)GBV needs to be addressed as well as inequal gender norms by service providers and the normalization of domestic violence in communities, in a broader sense.
Recent data from a national survey in GBV and the DHIS (Demographic & Health Information System) counted 30,010 GBV survivors in the first quarter of 2022, which is an increase of 39% compared to the same period in 2021. Most cases are reported from North Kivu (10,384 cases, 35% of the total) followed by South Kivu (5,427
 
cases, 18%) and Ituri (3,828, 12,7%). 95% of the cases documented involved female SGBV survivors. In addition, according to this report, only 70% of the reported adult survivors and 40% of the reported child survivors received medical attention within 72 hours after the incident. It is reported that 58% of cases received psychosocial assistance and that 3% of female survivors went to a safe house and 13% of survivors in Ituri province received a socio-economic package.
These data are far from accurate. Trends might reflect elevated violent episodes with armed attacks in communities, but also more willingness to report and improved registration systems with the authorities in relation to ongoing SGBV projects by government and NGOs alike. However, it is clear that the reported cases represent the tip of the iceberg of the real numbers. Internationally, around 25% of survivors of sexual violence are estimated to disclose the assault, which is likely to be less in conflict settings, due to several factors, such as stigma, shame, fear of reprisals, normalization of violence and impunity of perpetrators (Johnson et al. 2010).
The position and health of girls and women in the Kivus is structurally poor due to negative gender norms, harmful practices such as forced child marriage, low education levels of girls, tolerance and normalisation of domestic violence against women and children, and negative attitudes towards family planning. The following data from MICS 3 demonstrates that: (1) Early marriage: Marriage before age 15 in South Kivu: 11.5%; North Kivu: 9.2%. Marriage before age 18: South Kivu: 29.2% and North Kivu: 28.2%. (2) Level of education of girls in primary and secondary school: South Kivu: 20.2% of girls are out of school compared to 16.7% of boys. North Kivu: 18.6% of girls against 19.5% of boys out of school. (3) Sud-Kivu: 73.5% of women between 15 and 49 think that it is justifiable for a husband to beat his wife in certain circumstances and 22.6% in Nord-Kivu. The situation is worsened due to unreliable access to sexual and reproductive health services, and specifically due to frequent stockouts and non-availability of contraceptives, PEP (Post-Exposure Prophylaxis against HIV infection), and antibiotics against sexually transmitted diseases (STIs). Poverty, lack of food and income, stigma of (S)GBV survivors also bring many young women to flee from their own communities and to be forced for their survival to engage in transactional sexual encounters for food. This problem is particularly more pronounced amongst IDPs and refugees, as well as in mining zones. In other areas of the Kivus, women and girls who are farming in the fields or who search for water or firewood for their household, are extremely vulnerable to become a random victim of sexual violence due to masculine norms and weak security services. As an illustration, 52% of women from the age of 15 in the DRC have suffered from physical violence and an intimate partner is mentioned as the perpetrator in almost 70 % of cases.
DHIS2 data (Demographic & Health Information Statistics) for North-Kivu show that a maternal mortality rate of 300/100,000 livebirths were reported and a contraceptive prevalence rate of only 8% of eligible couples. In addition, approx. 10,000 new cases of (S)GBV were recorded in North-Kivu. These figures are for South-Kivu in the same period were 148/100,000 for maternal mortality, 13.7% contraceptive prevalence rated, and approx. 4,000 new cases of (S)GBV recorded.
About 27% of women in DRC report having been sexually assaulted in their lifetime. Statistics show that in eastern DRC, 17% of women who were raped reported becoming pregnant as a result of an attack. In 2008, the DRC ratified the African Union's Maputo Protocol, which states that abortion should be legal in cases of sexual assault, rape and incest, and to protect the mental and physical health of the mother or the life of the mother or the fetus. The Protocol gained legal authority in 2018 when it was published in the DRC's Official Gazette, a step that formalised the government's obligation to allow access to safe abortion under the terms identified in the Protocol. Under the DRC's legal system, international laws override national laws so this law should normally be applied in the DRC.
However, in the DRC, there are many obstacles to accessing safe abortion:

	Many Congolese legal experts and police officers are unaware of the change or may choose not to follow the law, leading to arrests of health care providers if it is enforced;
	Inconsistent understanding and application of the law by legal institutions and law enforcement officials;
	Slow integration of the Maputo Protocol into national laws;
	The defense of traditional customs and values that are pro-natalist and deny abortions (even a woman experiencing a repeated spontaneous abortion is highly resented by her family).
	Religion: the DRC has 90% of Catholic faithful and countless revivalist churches, sexuality and reproductive health issues remain taboo;
 
	The severe stigma against women who seek or have had an abortion;
	Difficulty in accessing care due to lack of infrastructure, equipment and even trained reproductive health personnel;
	Financial access limits the population's ability to access reproductive health care.
	Existence of limited services in a few urban areas and a few private facilities performing safe abortions in secret.
Since 2009, the Congolese state had adopted a stabilisation framework with the STAREC programme, implemented in line with the international stabilisation strategy Stratégie Internationale de Soutien à la Sécurité et la Stabilisation de l’Est de la RDC (I4S) aiming for long term peace, strengthened institutions and inclusivity (SDG16) with a focus on contribution to restoration of state authority, democratic dialogue, and gender equity. In March 2022, the DRC government and its technical and financial partners adopted a new national DDR (disarmament, demobilisation and reintegration) strategy that also integrates stabilisation within a holistic and community-based approach to support the reintegration of ex-combatants into the community. This strategy, known as the PDDRC-S, has become the main vehicle through which stabilisation activities are undertaken and supported by the DRC government. Its technical and financial partners have adapted to this new policy framework and are considering how best to integrate the lessons learnt from previous stabilisation programmes into this new approach, to capitalise on the many results achieved in previous stabilisation policy frameworks. Though efforts were made throughout the years on i) the active engagement of communities and community leaders in addressing local conflicts and addressing (S)GBV; ii) engaging women as agents of change; iii) the conflict-sensitivity of interventions (“do no harm” principles”); and iv) improved access to life-saving reproductive health and (S)GBV services, they are still insufficient in reach and effect until today.

1.2	Sexual and Reproductive Health and Rights (SRHR) and (S)GBV in health systems

In times of conflict, access to family planning services is one of the first things women lose. SRH rights are factors of peace and stability as they reduce inequalities and contribute to social and demographic changes. Important demographic and health data indicate an annual population growth rate of 3.27%, with one birth every 9 seconds, one death every 39 seconds, one net migrant every 28 minutes and a net gain of one person every 12 seconds in DR Congo.1
Maternal, infant and under 5 child death rates are preventable in case of access to quality health services. These death rates, however, are particularly high in unwanted pregnancies and motherhood, for instance after non- consensual sexual encounters or in situations of lack of contraceptives at the health services.
Poverty and population growth mutually re-enforce each other. If the unmet demand for contraceptives could be fully met in the Kivus, then it is estimated that one would reduce at least 40% of pregnancies and more than 50% of related mother- and infant deaths. The provision of contraceptives is by far a cheaper and less worrisome service than the treatment of complications of pregnancy and giving birth.2 Only 12.4% of couples in DR Congo use a form of modern contraceptives, while there is an unmet need of 39.4% for Family Planning in DR Congo (UNFPA 2019).
One of the principal reasons for the prominent level of unmet need is the breakdown of the supply chain of contraceptives at various levels, resulting in stock outs at health facilities and the community level. Despite the SRHR programmes, like S3G, or the GFATM programme, there are not enough contraceptives and antibiotics (against STIs and other infections after sexual violence) available in the national Congolese market for large- scale purchase by the public sector. Despite annual planning and budgeting by the Ministry of Health in DRC on contraceptives and on rape kits, the expenditures were limited or absent on these government budget lines for the past two years due to competing priorities. Geographic complexity, combined with periods of heavy rainfall, regular outbreaks of violence by armed groups and political instability make the Kivu region particularly complex. This combined with a poor communication infrastructure and insufficient qualified human resources for health logistics operating in low resource settings, lead to poorly performing logistic management and a poor information system that does not provide the data needed to forecast, quantify, order and supply SRH commodities (from either public or commercial sources) in a timely fashion. Contributions S3G project to the EKN Strategy Medium Term Objectives
STRATEGY MEDIUM TERM OBJECTIVES
1	Contribute to reduction of violence against women and girls (S3G pathway 1 and 3)
2	Contribute to promotion of SRH Rights through advocacy, community mobilisation,
     comprehensive sexuality education that reaches young people and adolescents (S3G pathway 3)
3	Strengthen health systems to support provision of SRH services and specifically to GBV survivors (S3G pathway 2)
4	Promote continuous availability and affordability of Sexual and Reproductive Health (SRH) commodities and services (S3G pathway 2) The primary target groups of this project are:
1.	(S)GBV survivors seeking (S)GBV services at the nearest health centres and at One Stop Centres for holistic recovery, justice and rehabilitation services;
2.	Clients with access to family planning information and services;
3.	Young persons with access to HIV and STIs information and services;
4.	Women and men, particularly youth, of communities who seek SRHR information, services and SRH commodities.

The secondary target groups include those professionals and community-based volunteers who will respond to (S)GBV or who will be influential in advocacy on prioritisation of a coordinated multi-sectoral response to (S)GBV in the selected geographical area and society at large. For example:
1.SRH service providers and (S)GBV service providers in existing health facilities; they are mainly 
    midwives and nurses, general medical doctors and psychosocial assistants (PSA);
2. Pharmacists, pharmacy-assistants and health staff in charge of health commodities and part of 
    the supply chain management (SCM)
3. Women’s Saving and Loans Groups (AVECs)
4. Community GBV focal points or « Communautés protectrices »
5. Community Health Development Committees, so-called “CODESA”
6. Community Womens groups (Wamena)
 
7. Members of technical and policy-making platforms at provincial levels, both in the health sector and in the multi-sectorial GBV technical committees under the Provincial Ministries of Gender
8. Police officers from police units in the geographical target areas, in collaboration with the ESPER project
9. Legal and juridical experts, in collaboration with the ESPER project
10. Journalists and media experts
11. Young men’s groups
12. Teenage mother associations