WEBVTT

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With one in thirteen chance of dying in
childbirth, women in Sub-Saharan Africa

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must feel they are in a combat zone. So when
they are really caught up in civil conflict,

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it\'s like being on the frontline twice
over. We asked Dr. Grace Kidindo,

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one of Africa\'s top doctors to find out what it\'s like
on the frontline in the Democratic Republic of Congo.

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[music]

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[music]

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My name is Grace Kidindo, I\'m a doctor

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and a obstetrician. I\'m traveling to
Eastern Democratic Republic of Congo,

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where for many years a
series of military conflicts

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have been raging. For years, Dr.
Grace Kidindo

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fought to save lives in ill
equipped maternity wards,

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in her native Chad. She is 3.100.
You know, dehydrated.

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She\'s asking for water. TV documentaries
and the press recorded her teams struggle.

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We had one this on Saturday,
Sunday, and Monday, this morning,

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but this morning we had two. Her achievements
have been honored with international awards.

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She\'s been invited to address the UN.

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Do woman from poor country really
have the same right to life and hers

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as their sisters in rich countries? Grace now
works with the Columbia University Program,

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helping to improve reproductive health
care for people affected by war.

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This mission to Congo to find out more about
women\'s special needs in conflict zones.

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I\'ve come to see for myself the impact

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of the fighting on its main
victims, the women and children.

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Grace is traveling to North Kivu,

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a war torn region in eastern Democratic
Republic of Congo. It\'s still highly insecure.

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The humanitarian agency is
providing her transport,

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refused UN armed escort. They believe its
safe here to avoid direct association

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with the conflict, but they must
constantly report their position.

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[sil.]

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Grace aims to meet as many people
affected by war as possible,

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but she\'s in for a shock. She\'s
seen what neglect can do to women,

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but not yet active conflict. Nineteen year
old Yvonne Salome was attacked by soldiers

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as she made her way to her parent\'s field.
Yvonne, tell me what happened.

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They dragged me into the
forest and raped me.

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I hid myself away because I didn\'t want anyone
to know. Only when I found I was pregnant,

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did my parents send me to the clinic.

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Some believe rape survivors are
cursed and will die in childbirth.

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Many women here die.

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When you\'re pregnant, you have to praise the God.
It\'s only by God\'s grace that you survive pregnancy.

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Her parents did not know

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how critical time is in the
hours, in this following rape.

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She is a very strong person. She\'s
even worry about how to find clothes

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for her future baby. Still, I
was not emotionally prepared

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to uh… to talk to her.

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Why is that? Well, because
to see such a young girl

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going through such a traumatic

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uh… event and still being
strong enough to talk

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uh… about what she\'s going through.
She\'s very calm.

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She\'s uh... She\'s… She\'s showing
that, even if she has, she\'s afraid,

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but she\'s still trying
to keep herself together

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and trying to go through this pregnancy.

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[music]

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Rwanguba health zone,

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epicenter of the fighting. Many
who fled, have started to return.

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Things not yet back to normal,

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but the damaged hospitals and
clinics are starting to function.

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Dr Serge Ilunga is a brave man.

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He stayed at his post to
meet the worst of the war.

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The main house impact of the war
is rape and sexual violence.

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What other health issues
apart from sexual violence?

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Many fled into the bush, so they
didn\'t give birth in the hospitals.

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Many mothers died along with their babies.

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[sil.]

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In conflict zones, women in labor are
unlikely to make it to a qualified doctor,

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much less to a hospital, so they
have to rely on one of these.

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This emergency birth kit consists of a
sterile plastic sheet, soap, gloves,

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a razor blade, and medical tape. For a
woman giving birth while on the run,

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it can make the difference between life and death
for her and her baby. The hospitals also stopped

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with another lifesaver, pep kits,
which include emergency drugs

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to protect rape victims from pregnancy and
sexually transmitted infections, including HIV.

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Can you prevent mother to
child infection of HIV?

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Yes, we can. That\'s good. But
Grace\'s years as an obstetrician

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in some of Africa\'s poorest hospitals
have sharpened her eye for details.

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This is an area with some of the highest
maternal mortality rates in the world,

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yet the hospital register seems
unusually free of maternal deaths.

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Do you never have maternal death? No.
You never had a maternal death.

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No. The hospital register records
about a thousand births a year.

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Grace feels the complete
absence of maternal deaths

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is implausible. So this is
your register of births?

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Yes, this is our register.
How do you explain this?

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There\'s not one thing that maternal death.
Do they die on the road or in their houses?

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We don\'t have any figures. You mean, there\'s
no cases of maternal deaths in the whole area?

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Well, it could happen, but it\'s rare.

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Noor, are there any recorded
cases of HIV positive patients?

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We get many STD infections
but hardly any HIV.

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Only when Grace pursues the issue,
does the reason for the seemingly low

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prevalence of HIV infection became clear.

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Actually running HIV checks here is
difficult, because we don\'t have

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the property agents for testing. Despite
the shortcomings by local standards,

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this hospital is well equipped. Grace
sets off to look at conditions

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further off the beaten track.
All along the way,

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signs of the fighting that\'s taken the
lives of five and a half million people

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in the last decade. The Congolese
army has fought its way

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against half a dozen of all rebel militias.
Only recently, as the UN

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broke it a fragile peace with 17,000
blue helmets now on the ground.

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[music]

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Things are far from certain.

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And aid worker has just been killed.

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You can still hear sporadic shooting
at any time of the day or night.

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Grace is keen to meet people who have
returned since the fighting subsided.

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Their stories are a poignant reminder
of why reproductive health care

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is such a critical need in conflict zones.
She meets two couples,

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both women gave birth while
fleeing the conflict.

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I had been given an emergency birth kit,

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which I put in my bag, but
we were robbed as we ran.

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Aster gave birth while on the run,

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without the emergency delivery kit.
Her baby died soon after.

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Clody Moyambi(ph) was luckier.

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Her husband was able to hang on to
their clean delivery kit as they fled.

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He delivered the baby himself
and the child survived.

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There was shooting everywhere as we fled.
My wife started having labor pains.

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So we went into some bushes.
I put on the rubber gloves

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and I cut the cord with a razor.

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It was cold and we had no baby
clothes, so I wrapped him in my scarf.

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It\'s very rare that the
husband deliver his wife,

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especially in Africa. This is… This
is my first time to hear about that.

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They had the clean delivery kit, and clean
delivering kit is something very basic.

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There is only one plastic sheet, one razor,

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string, small uh… soap and that\'s all,
but there can be difference between

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life or death because it
helps to prevent tetanus,

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which is one of the most uh… common cause of innocent
deaths or… or even maternal deaths from tetanus.

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[sil.]

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This is a family of 10 children,
there are 12 children.

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They have fled during the crisis, they come back. Now both
the husband and wife want to limit their children now,

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that they don\'t know where and how.

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So this is a typical case of
unmet need for family planning.

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[sil.]

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The Ritsoro Tom Health Centre was ransacked during the
fighting and still, only barely manages to function.

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This is the consultation
and observation room.

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Men and women are mixed in here.
It\'s all the space we have.

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Okay.

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What happens in case of birth complications,
such as hemorrhage or conversions?

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What do you do then? Immediately we see
them. So how do you get them to hospital?

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We’re filing a form. But
apart from the forms,

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how do you get them to the hospital? By
ambulance. And how long does it take?

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About an hour so… So then an hour the
patient is on her way to hospital?

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Thank you. Who helps with
the home births? No one.

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So it must be the traditional mid-wives
who help with the home birth? Yes.

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What if a rape victim comes in?
Yes, we\'ve got that kit. Can I see?

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I see you have anti-duovir virus.

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And do you have the morning after pill?
Yes. Mass rape has become a weapon of war

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in the Congo. [sil.]

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Martha Muvasis [12:31] was turned
upside down as she fled the conflict.

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Her husband and their four
children were with her.

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Some soldiers grabbed hold of me and
raped me. I needed medical treatment.

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Then my husband said, he
didn\'t want me anymore.

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When I got home, my house was burned down.

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As a result of the rape,
Martha was left pregnant,

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infected with gonorrhea and
alone with four children

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with no roof over their heads. Some
villages led to the use of an old house.

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This is where she\'s living
now, you can see that.

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The roof is almost out. So during the rain,

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water is just flowing over her and her
children. The story of this poor woman,

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with her four children
and fifth on the way,

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can just, you know, uh…
conclude the whole tragedy

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that people in this area of
conflict they are going through.

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Now she find herself if sexually
transmitted infection and a pregnancy,

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if, no means to live on. It\'s
really unjust for one person

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to go through this whole uh… tragedy.
It\'s really unjust.

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[sil.]

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Faced with the sheer scale of sexual violence against
women, the clinics here offer therapy programs

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to help repair broken lives.
These women are learning to sew,

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it can also help earn a living.

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Well done, good work.

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[sil.]

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To the west is Birambiso, an
area that\'s even less secure.

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Thousands of displaced people are in camps,

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huddle for safety around the UN bases.
But even here armed groups

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make a point of harassing them. All
these displaced people are congregating

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very near the UN forces for their safety.

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Last night at around 1:00 in the morning, some
rebels have shoot to intimidate the people

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and to show them have that, UN people cannot
always protect them. And this show how

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sensitive is the situation.

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[sil.]

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The population of three displaced peoples\'
camps, as well as the local village of Katsiru

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are served by a makeshift health center.

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How many people are served by this clinic?

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With the counts, there are 17,000.
With so many displaced people,

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the clinic is struggling to cope. Women
in labor have to share a room with people

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of all kinds of diseases.

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In the delivery room, Leonior(ph) is about to give
birth. She\'s praying there will be no complications.

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What happens if she has complications?

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Say she has hemorrhages or eclampsia?
The villages make a stretcher

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and carry her to another clinic.
How far is that?

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Twenty kilometers. Twenty kilometers?

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This is the pharmacy. This tiny cupboard
contains the clinic\'s entire stock of medicines.

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It serves the medical
needs of 17,000 people.

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How many cases of rape do
you get here in a month?

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Twenty rapes a month. Do you have pep
kits and the morning after pills?

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We don\'t have any. Can you
give antibiotics? No.

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There are none? We only have tiny amount.

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So you\'re not medically equipped for this
situation? No, we are not equipped to deal with it.

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For the sexual violence situation.
That\'s right.

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So you can\'t run HIV checks to prevent
mother to child transmission?

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No, we just don\'t have the means.
You don\'t have the means?

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As you can see we don\'t have the means. You don\'t even
have sterile gloves, nothing? Not even delivery kits.

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You don\'t have delivery kits? Are there
any female mid-wives working here?

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There was one but she left. She told us,

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she will prefer to work somewhere else.
Because of the lack of equipment, she left.

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[non-English narration]

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What do you do if a woman gives birth, but
the placenta doesn\'t come out properly?

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I try to get it out with my fingers.
If that doesn\'t work, we\'ll refer her.

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Can I see those stock of condoms?

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This is our stock of condoms. Okay. So
these are all the condoms in the clinic,

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just three? And what about
oral contraceptives?

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Can I see what you\'ve got?
You have Azurettes?

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Azurettes are a contraceptive pill prescribed
for mothers who are breastfeeding.

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This is the only type you have? Yes.

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That\'s not enough. We only have a few.
You only have a few?

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[sil.]

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Outside, a group of women who\'ve been
patiently waiting to talk to Grace.

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They\'re all survivors of rape. Are they happy
to talk to us? They don\'t feel embarrassed?

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No, they are not embarrassed. The
women are keen to tell their stories.

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The soldiers take me
screaming into the forest.

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I was claiming that crazy
people thought (inaudible).

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They were too scared to come and help.
Were you tested for HIV?

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Yes, they tested me for HIV,

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but I still have the lower back pain.

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I\'m on the bed, you know.

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Are all these ladies victims of rape? Yes.

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So all these children are the
product of sexual violence?

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Yes, that\'s right.

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[sil.]

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Twenty five year old [19:49] was left
pregnant after a group of soldiers raped her.

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When my husband found out, he
threw me out of the house,

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I ran away. How did you give birth?

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They can\'t help me at the clinic, so they
sent me to the hospital in Nyanzale,

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where I had a caesarian. You\'re very lucky.

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If you hadn\'t that caesarian, you
and your children could have died.

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Twenty percent of population

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living in the camp, but the large
majority are living outside the camp.

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They have no access at all to surgeries
that can help save their lives.

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So this woman is really
one of the luckiest.

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How many of you are abandoned by your
husband as a result of being raped?

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I\'ve talked, there are 60 victim

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of rape that are here today,

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58 of them have been abandoned by their husbands,
only two are still with their husbands.

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[sil.]

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Fear of attack while asleep in
their beds is forcing many people

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to hide in the bush at night, only returning
to their villages in the morning.

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[music]

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All across Birambiso, Grace finds women
who want to space their pregnancies

00:21:40.000 --> 00:21:44.999
and doctors and nurses
willing but unable to help.

00:21:45.000 --> 00:21:49.999
If only I knew how to delay my
pregnancies, I would do so.

00:21:50.000 --> 00:21:54.999
Can you help her? In theory I
can help her, but in practice…

00:21:55.000 --> 00:21:59.999
I mean, can you give her
contraceptives now? What, now? Yes.

00:22:00.000 --> 00:22:04.999
No, I haven\'t got any. There are not contraceptives
in the whole of Birambiso health centre. None?

00:22:05.000 --> 00:22:09.999
It\'s a real need for the whole
population around here. Absolutely.

00:22:10.000 --> 00:22:14.999
Grace wants to hear a male perspective. Haragira
Bitabi lost his five children in the war.

00:22:15.000 --> 00:22:19.999
He and his wife now live in a displaced
people\'s camps. He\'s a suspected case of T.B..

00:22:20.000 --> 00:22:24.999
We sleep in fear.

00:22:25.000 --> 00:22:29.999
The women are fear of being raped and
mutilated. Why do men abandon their wives

00:22:30.000 --> 00:22:34.999
when they\'ve been raped? They\'re
scared of getting infected.

00:22:35.000 --> 00:22:39.999
Some people believe rape
is the woman\'s fault.

00:22:40.000 --> 00:22:44.999
What do you think? No, it\'s not her fault,

00:22:45.000 --> 00:22:49.999
but also be scared of getting infected. So
I\'ll make sure she was treated at the clinic

00:22:50.000 --> 00:22:54.999
before taken her back home,
but I wouldn\'t abandon her.

00:22:55.000 --> 00:22:59.999
Have you heard about male rape? We find
it very disturbing and we\'re scared.

00:23:00.000 --> 00:23:04.999
I\'m also scared for myself.
I\'m scared to go to my fields

00:23:05.000 --> 00:23:09.999
on my own.

00:23:10.000 --> 00:23:14.999
Many people don\'t like talking about male
rape, so cases maybe higher than most assume.

00:23:15.000 --> 00:23:19.999
How many? Among men, it\'s
at least 20% and for women…

00:23:20.000 --> 00:23:24.999
So 20% of rapes are men and 80% women? Yes.

00:23:25.000 --> 00:23:29.999
So it could be higher than 20%? Yes.
But what we see here is our own

00:23:30.000 --> 00:23:34.999
20% of rapes on men. So it could be more
because most men just wouldn\'t come,

00:23:35.000 --> 00:23:39.999
because of shame. Because
of the shame, yes.

00:23:40.000 --> 00:23:44.999
[sil.]

00:23:45.000 --> 00:23:49.999
Back in Katsiru, Leonia has given birth.

00:23:50.000 --> 00:23:54.999
Any complications would have meant a four
hour trek on a stretcher to a clinic.

00:23:55.000 --> 00:23:59.999
Decent supply of cheap drugs and medical
equipment would make such journeys unnecessary.

00:24:00.000 --> 00:24:04.999
Where do ever begin ending the suffering

00:24:05.000 --> 00:24:09.999
and end to impunity?

00:24:10.000 --> 00:24:14.999
Justice seems as good a place as any.

00:24:15.000 --> 00:24:19.999
By chance grace comes across
a roadside court martial,

00:24:20.000 --> 00:24:24.999
a group of soldiers and their
officer\'s stand accused of raping

00:24:25.000 --> 00:24:29.999
and terrorizing civilians. The symbolism
does not escape some local women.

00:24:30.000 --> 00:24:34.999
They\'ve been waiting all
day to witness the scene.

00:24:35.000 --> 00:24:39.999
Women in the world\'s conflict zones need
medical help and they also need justice.

00:24:40.000 --> 00:24:44.999
[non-English narration]

00:24:45.000 --> 00:24:49.999
You are each sentence
to lifetime hard labor.

00:24:50.000 --> 00:24:54.999
[sil.]

00:24:55.000 --> 00:24:59.999
Although only a beginning.
This is a real sign of what?

00:25:00.000 --> 00:25:04.999
By far the biggest
casualties of this conflict

00:25:05.000 --> 00:25:09.999
are civilians, not defectors
and women and children

00:25:10.000 --> 00:25:14.999
suffered the most, their
need is the greatest.

00:25:15.000 --> 00:25:19.999
Reproductive health care must be
seen as a frontline priority,

00:25:20.000 --> 00:25:24.999
not something to think about
only after the fighting is over.

00:25:25.000 --> 00:25:30.000
[music]