The Right to Survive:
Sexual Violence, Women and HIV/AIDS

Françoise Nduwimana
December 2004

© International Centre for Human Rights and Democratic Development, 2004.

The opinions expressed in this book are the author’s own and do not necessarily reflect the views of Rights & Democracy. This report may be freely excerpted, provided credit is given and a copy of the publication in which the material appears is sent to Rights & Democracy.

Project Coordinator and Editor: Isabelle Solon Helal, Programme Officer, Rights & Democracy, with the collaboration of Ariane Brunet, Coordinator, Women's Rights, Rights & Democracy

Translation: Janis Warne

Production: Anyle Coté, Officer, Special Events and Publications, Rights & Democracy

TABLE OF CONTENT

Preface

Introduction

Rwanda

Genocide, Sexual Violence and Propagation of HIV/AIDS

• Pretending HIV/AIDS Doesn't Exist: Reasons for Silence
• Women and Hate Propaganda
• From Hatred Towards Women to Sexual Violence and HIV/AIDS
• Indicators of HIV/AIDS Transmission Through Rapes Carried Out During the Genocide

The need for justice and reparation

• Medical Assistance for Witnesses and Victims Provided by the International Criminal Tribunal for Rwanda
• Respecting ICTR Medical Care of Witnesses, Including Access to Triple Therapy
• Compensation of Victims of the Rwandan Genocide by the ICTR
• Recommendations to the ICTR

The Role of the Rwandan Government

• Inadequacy of Resources
• Problem of coordination
• High Costs of Triple Therapy and the Exclusion of Women
• Recommendations to the Rwandan Government

Humanitarian Organizations and International Cooperation

• Doctors without Borders
• Recommendations to Humanitarian and International Cooperation Agencies
• Coalition for Women's Human Rights in Conflict Situations
• Rwandan Women’s Rights Associations

The Regional Context in Africa

Armed Conflict and the Spread of HIV/AIDS

• Violence, a Vector of HIV/AIDS
• Women in the Crossfire
• Women and Poverty

Women and Gender-Based Crimes

• HIV Prevalence in the Armed Forces
• The Military Code of Conduct

Women Refugees and Displaced Persons

Challenges for the Sub-Saharan Region

• Victims Rights to Justice and Reparation
• Recommendations

Conclusion

Appendix:
Testimony of women who were victims or rape and HIV/AIDS during the Rwandan genocide

Homage and Acknowledgements

Endnotes

Preface

In her latest report on violence against women, its causes and consequences, (1) Ms. Yakin Ertürk, UN Special Rapporteur, drew attention to the fact that HIV/AIDS intersects many forms of violence against women. Among them, rape and other acts of violence commonly carried out in the scope of armed conflict considerably increase women's vulnerability to HIV/AIDS. (2)

Rights & Democracy's Women's Rights Programme made the decision to fund and publish this study in response to the Special Rapporteur's appeal for more research on the subject and the need expressed by the Coalition for Women's Human Rights in Conflict Situations to better respond to the unparalleled situation experienced by women who were raped and infected with HIV/AIDS during the Rwandan genocide.

This essay is divided into two parts. The first part discusses the specific case of the Rwandan genocide and the second, the armed conflicts plaguing sub-Saharan Africa. Any analysis of the violence perpetrated against Rwandan women is incomplete without a full comprehension of the very logic underlying the genocide of Tutsis and the massacres of Hutus opposing the genocide. The genocide was the work of the State, its administration, bureaucracy, army, militias and the structures implemented to foment ethnic hatred and to incite the majority of the population to participate in the “final solution”. As Jean-Pierre Chrétien (3) points out, the Rwandan genocide is the result of an ideology and a successful and persistent propaganda campaign. One million deaths in one hundred days, thousands of rapes and acts of sexual violence, committed without regard to the victims' ages and throughout the country: this constitutes a record of rapid and “efficient” destructiveness that no other African country has ever known. The African regional context, in which many armed conflicts are being played out, requires a different analysis. Unlike the Rwandan genocide, which lasted 100 days, those conflicts are characterized by their long duration of between 10 and 30 years. In addition, while the Rwandan genocide was the work of a State, the crisis in Sierra Leone and the Democratic Republic of Congo (DRC) have demonstrated a regionalization of civil war in terms of the size of military forces, armed groups and the number of countries involved.

The first part of the essay is a monograph written using data, interviews and accounts gathered in Rwanda in February 2004. We met with 30 victims, members of survivor women's associations in Kagugu, Taba, Cyangugu, Butare, Kigali, Ruhengeri and Nyanza, and 18 women gave their personal accounts of events. This section recounts the sexual violence and the high level of HIV/AIDS among these surviving women and its relationship to the genocide, the hate propaganda and the underlying ethnic violence. In addition, the victims' rights to reparation and psychological and physical rehabilitation should clearly be of concern to the International Criminal Tribunal for Rwanda (ICTR), the Rwandan government and international cooperation organizations.

Jean Louis Roy, President, Rights & Democracy

Introduction

This year, Rwanda commemorates the tenth anniversary of a tragedy that has marked the collective memory: the genocide of Tutsis and the massacre of Hutus who opposed it. According to the latest statistics published by the Rwandan government on the occasion of this tenth anniversary, 934,000 people lost their lives during the 100 days of the tragedy. Although today we commemorate the dead, and keep their memories alive, one reality is disregarded and it is that despite the official end of the genocide, lives continue to be forfeited. For many of the women who were the victims of rape during the genocide as part of a larger strategy of ethnic extermination; the relationship of rape to the genocide is not solely a matter of history. The challenge for these women is not merely to keep the memory of the tragedy alive but to reclaim their right to leave the nightmare of the genocide behind, the right to survive.

The 30 women who were the subject of this study, including 18 who related their personal stories, have something in common. They were all raped during the genocide and infected with HIV/AIDS. Can we accurately refer to them as survivors, when every day, these women, linked by the miserable three-pronged destiny of genocide, rape and HIV/AIDS, witness their friends, acquaintances, neighbours, and family members dying in anonymity, with the world utterly indifferent to their fate? Can we accurately refer to them as survivors when, in the absence of treatment for HIV/AIDS, those who are still living see only death on the horizon? While these women, victims of rape and HIV/AIDS, did not die during the 100 days that rocked Rwandan history, they have been visited with another form of atrocious, unnameable and insidious death. They are dying slowly, an invisible extermination. They are demanding justice. What was the point of surviving only to die a few years later, completely disfigured and dehumanized? Survival is not an imperative stripped of substance and meaning. It depends on social justice measures that can help people put their war-torn lives back together and make a new start. In the absence of health or social measures, such as access to HIV/AIDS treatment, women who have been raped and who are living with HIV/AIDS are condemned to death.

This study is a plea for these women's right to survival. They are in this situation because they were victims of genocide. It would be a betrayal of memory to say that they are victims of HIV/AIDS only. The women were infected with HIV/AIDS in the very specific context of the genocide. In such a circumstance, HIV/AIDS cannot be considered uniquely as a disease transmitted during sexual activity. In the context of rape and physical violence, HIV/AIDS infection is criminal in nature and requires a different response. As it is blatantly clear that the high incidence of HIV/AIDS, estimated at between 66.7% (4) and 80% (5) among surviving women, is closely linked to rape and the other physical violence suffered by these women during the genocide, the justice system must include HIV/AIDS as one of the consequences of these crimes and adopt the appropriate legal and reparation measures.

Rwanda

For 60 days, my body was used as a thoroughfare by all the hoodlums, militia men and soldiers in the district… Those men completely destroyed me, they caused me so much pain. They raped me in front of my six children… Three years ago, I discovered I had HIV/AIDS. There is no doubt in my mind that I was infected during these rapes… Here in the village, we are 200 Hutu and Tutsi women united by the Rwanda Women's Network. It disgusts us to see the treatment given to prisoners in Arusha while we are left to our own devices. We were killed once and we are now dying because of lack of drugs. What did we do to deserve such a punishment? I speak on behalf of my children because I no longer exist. What will happen to my children?
Statement taken from a survivor at the Polyclinic of Hope in Kagugu, prefecture of Kigali.

Genocide, Sexual Violence and Propagation of HIV/AIDS

On June 28, 1994, after the publication of the enquiry report of the former UN Special Rapporteur on Rwanda, René Degni-Ségui, (6) the UN Commission on Human Rights formally acknowledged the Rwandan genocide. In points 43 and 48 of his analysis differentiating categories of massacres, the Special Rapporteur confirmed that it was judicious to refer to the massacres in Rwanda as the genocide of the Tutsis as a social group.

The Commission of Experts created on July 1, 1994 by the UN Security Council confirmed in its report, (7) in accordance with Article II of the Convention on the Prevention and Punishment of the Crime of Genocide, that genocide had been committed against the Tutsis and strongly recommended the creation of the International Criminal Tribunal for Rwanda. With respect to women, a later report by Degni-Ségui, (8) submitted on January 29, 1996, revealed the magnitude of the sexual violence during the genocide. The report stated that rape was used as a weapon of war against women aged 13 to 65 and that neither pregnant women nor women who had just given birth were spared, that it was systematic and constituted the rule and its absence, the exception. In the absence of exhaustive investigations, the Special Rapporteur estimated that the figure of 15,700 rapes recorded by the Rwandan Ministry for the Family and the Promotion of Women underestimated the real number because it did not take into account women who had been raped in refugee camps and outside Rwanda's borders.

He added that the absence of data was related to the fact that most of the women who had been raped were reluctant to talk about it. Using the number of women who became pregnant after the rapes (2000-5000) and based on the hypothesis that one hundred cases of rape give rise to one pregnancy, he estimated that between 250,000 and 500,000 women were raped during the genocide. According to many observers, this method of estimating is questionable, although there is consensus that during the Rwandan genocide rapes were committed on a large scale.

We will probably never know the exact number of rapes committed during the Rwandan genocide, just as we will never know the exact number of women who were infected with HIV/AIDS through sexual violence. In any case, the challenge we now face is to respond to the known consequences it has had on its victims.

Point 20 of the above-mentioned report, on the consequences of rape, underscores the extremely troubling situation of victims who contracted sexually transmitted diseases, particularly HIV/AIDS. The Special Rapporteur stated that “the militiamen carrying the virus used it as a ‘weapon,' thus intending to cause delayed death.” (9) In addition, the international organization African Rights, the first to publish a detailed analysis of the genocide, (10) presents HIV/AIDS and other sexually transmitted diseases as the legacy left to women raped during the genocide. Later work focused exclusively on violence against women has shone a clearer light on the nature, breadth, consequences and authors of rape and other physical atrocities inflicted on women. The first large-scale study, written in 1996 by Binaifer Nowrojee, (11) is a joint publication of Human Rights Watch (HRW) and the International Federation of Human Rights (FIDH). The second study is the report by the former UN Special Rapporteur on violence against women, Radhika Coomaraswamy. (12)

It is striking to see how, barely two years after the genocide, HIV infection had officially been noted as one of the consequences related to rape. In addition to the concerns expressed in this matter by Degni-Ségui, the HRW/FIDH report, while admitting the difficulty of proving with certainty that transmission of HIV/AIDS occurred during the rapes, states “Nonetheless, it is certain that some women were infected with the virus as a result of being raped.” In addition, based on statements of victims such as Jeanne (13), whose rapist did not hide his ultimate intention when he told her “I have AIDS and I want to give it to you,” Radhika Coomaraswamy affirms that “[t]here are many women like Jeanne who survived the genocide only to be left with AIDS.” (14) The Special Rapporteur stated that she was “deeply concerned at the lack of medication available for persons with HIV/AIDS, and especially for women survivors who were infected through rape and sexual violence during the conflict.” (15)

Pretending HIV/AIDS Doesn't Exist: Reasons for Silence

The burning question is why, when the existence of HIV/AIDS was known, and that without a doubt, it would predispose the victims to certain death, were measures not taken to find out more and care for those who survived the genocide? The statements of the victims interviewed for this study provide part of the answer. (16) Only a small number of rapists told the victims while raping them that they were also transmitting a slow death, in the form of HIV/AIDS.

Several years went by without women suspecting that they had HIV/AIDS. Many women began presenting with signs of the disease between 1999 and 2002. This corresponds to the incubation period for HIV/AIDS, which is estimated to be between three and ten years. It is also important to stress the urgent problems these women were confronted with at the end of the genocide. Physical and psychological injuries had to be tended to, they had to find food to eat, and a place to live, find lost children, etc. The extreme poverty in which women found themselves did not allow them to think further than their immediate situation.

Consolée Mukanyiligira, (17) president of the Association of Genocide Widows (Association de Veuves du Génocide d'Avril – AVEGA-AGAHOZO) sums up the situation this way [translation]: “These women are very vulnerable. They have lost everything, their husbands, their material support. Most of them depended on their husbands, they have no diplomas, nor activities that can generate income. From 1995 to 1997, AVEGA mainly sought emergency assistance: clothing, food, etc. The International Committee of the Red Cross (ICRC) was our main benefactor. Thirty percent of AVEGA's members still do not have a fixed domicile despite efforts to build homes. The need for housing is desperate as are all other primary needs.”

However, responsibility for women's health was not solely that of victims and women's groups. It was, above all, the responsibility of the government and of international cooperation organizations. While it is true that Rwanda was dealing with several emergencies at once, it is also true that the health of the women should have been one of its priorities, as they were becoming sick following the rapes, in other words, because of the genocide. They were also caring for thousands of orphans.

It is estimated that in Rwanda, 400,000 children are orphans. Among them, 95,000 are AIDS orphans. Thirty six percent of Rwandan households are headed by women and 60% of them have no income and no support. Despite this, it is the women who are building the future of Rwanda. All the women we met in connection with this study are, on average, responsible for five children. The death of one woman can therefore mean that five children will become homeless or be uprooted.

This debate should be situated within the larger context of the right to health, and especially access to HIV/AIDS treatment (18) in poor countries. To understand the silence surrounding the women who were raped and who are living with HIV, we should remember that in January 2004, out of the 500,000 people with HIV in Rwanda, only 2000 (19) were receiving triple therapy, which consists of a “cocktail” of three different drugs that block replication of the virus and restore the immune system.

The same situation prevails throughout all of sub-Saharan Africa. Out of 30 million Africans living with HIV/AIDS, UNAIDS estimated that in June 2002, only 30,000 people (0.1%) were receiving treatment. It is also important to remember that on August 31, 2003, after the 21 months of negotiation that followed the Doha Declaration in November 2001, the World Trade Organization finally ratified the agreement on trade related aspects of intellectual property rights (TRIPs) allowing the manufacture, importation and exportation of generic drugs. Before ratification of this agreement, copyright law prohibited poor countries from importing or manufacturing generic drugs. Despite the agreement taking effect and the reduction in the price of antiretroviral drugs, the majority of women do not have the means to access them. In Rwanda, even though the price of antiretroviral treatment was reduced by 200%, i.e., from US$6000 per month in 1999, to US$30 in 2004, treatment remains inaccessible to persons with little or no income. (20)

It should also be noted that voluntary screening centres were basically nonexistent at the time of the genocide and afterwards. In 1998, four years after the genocide, there was only one voluntary screening centre in the entire country. (21) There are now over twenty. However, it should be noted that even though the screening test is free, one still must pay over US$50 (22) for laboratory examinations, which excludes many women who have no income and those living in the countryside, where the income level is between 2000 and 5000 FRw, or less than US$10. (23)

It was only at the end of 1999, almost five years after the genocide, that the first estimates were made of the number of women infected with HIV after being raped. The study carried out by the Association for Genocide Widows, AVEGA-AGAHOZO, was in fact, at the time, the only reference available and has since been frequently cited, including by the National AIDS Control Policy. (24) Carried out over three prefectures selected on the grounds that the surviving women are representational of the other survivors in the country (Kigali, Butare and Kibungo), the study established that 66.7% of the 491 cases of trauma, illness and other consequences of the rapes were HIV/AIDS-related. Out of the 491 women who had serious sequelae, 327 were HIV-positive. The study concludes that sexual violence was a primary tool of “ethnic cleansing.” (25) Since the AVEGA-AGAHOZO study, interest in the subject has continued to mount, as can be seen by recent publications by Save the Children, (26) Amnesty International (27) and African Rights. (28)

Women and Hate Propaganda

Like many other African societies, Rwandan culture is more oral than written. In the context of genocide, ethnic hatred was nurtured without leaving many written traces. This poses two challenges: how to collect evidence and how to interpret a language that uses figures of speech difficult for Western culture to decipher. The ethnic and sexist preconceptions that led to the deaths of Tutsis and moderate Hutus described by the genocide machine as traitors were not set forth in a Rwandan version of Mein Kampf.

In the absence of a genocidal plan written by the regime that orchestrated it, the two main scientific texts that contributed to uncovering the ideological basis of the Rwandan genocide were a study of the media (29) and a structural analysis of the genocide. (30) In Rwanda, the media constituted [translation] “the transductive vector through which the terrible venom of racist ideology was injected.” (31)

The only evidence in print, which was used to analyze hatred against Tutsi women, is the Ten Commandments of the Bahutus (No. 6, December 1990), published in the infamous newspaper Kangura. (32)Kangura's role in the genocide was well described during the media trial, (33) which the ICTR qualified as “hate media.” At the end of that trial, Hassan Ngeze, editor-in-chief of Kangura, and his co-accused were found guilty of conspiracy to commit genocide, of genocide, and of direct and public incitement to commit genocide, and extermination and persecution, all of which constitute crimes against humanity.

In fact, during the period preceding the genocide, and during the genocide itself, certain media, such as Kangura and Radio Television Libre des Milles Collines proved to be powerful vehicles of hate and ethnic violence. In his indictment against Hassan Ngeze, the ICTR prosecutor presented the “Ten Commandments of the Bahutus” as “not only an outright call to show contempt and hatred for the Tutsi minority but also to slander and persecute Tutsi women.” (34) Stereotyped and stigmatized through the prism of sexuality, Tutsi women, to whom the extremist press attributed sexual prowess, were portrayed as constituting a threat to the homogeneity of Hutu blood. Described as objects of temptation for Hutu men, Tutsi women were thus used as the preamble for a call to ethnic unity of Hutus.

Such a fixation on sexuality set the foundation for ethnic hatred against those women, who were reduced in this case to their sexuality. This raises two conflicting issues according to Rwandan culture. The first is the explicit recognition of the biological reality that women have the power to bring life into the world. The second concerns the term “Nyampinga” which defines women as citizens without ethnic affiliation because in Rwanda, affiliation is patrilineal.

Although in the case of Rwanda, the term “ethnic group” is not the most appropriate, it is true that a pre-colonization sociological construct has become a political reality. The challenge that today faces leaders and the Rwandan population in general is not to deny this established fact, but to stop using ethnicity to exclude and discriminate.

With respect to women, the fundamental issue consists of questioning the limits of the notion of Nyampinga. If women do not belong to any ethnic group, they should not have been subject to so much hate. How can this fear of seeing Hutu men marry Tutsi women be explained? How can it be explained that Hutu women who had married Tutsi men were accused by the genocidaires of treason to the Hutu cause, to the point of being subjected to the same torture and horrors as their Tutsi sisters?

Without attempting to vindicate women's right to an ethnic identity, because the problem is not so much one of identity as one of political manipulation, with women as the subject, it must be recognized that in Rwanda one is born Tutsi, Hutu or Twa, according to the ethnicity of the father. Paradoxically, in the context of genocide, women acquired an ethnic identity.

The transmission of HIV/AIDS was a triply effective weapon in the eyes of the genocidaires. A woman who had been raped and infected would be a potential source of contamination to her future partners, supposedly Tutsi; she would give birth to children who would have very limited chances of survival; and she would finally die, bringing several others with her.

From Hatred Towards Women to Sexual Violence and HIV/AIDS

Rwanda provides an historic regional precedent respecting violence committed against women in the context of war because of the extent and forms of the sexual violence committed during the genocide. It was also an historic precedent judging from the exportation of the Rwandan model to the rest of the Great Lakes Region and considering how commonplace those practices have become. Colette Braeckman (35) sums up the situation in these words [our translation]: “Everything happened as if the paroxysm that the violence had reached in Rwanda was diffused throughout the entire region, lifting all restrictions and authorizing all forms of dehumanization.”

To understand what this paroxysm consisted of, one must remember that the rapes were often gang rapes and occurred over a long period. Among the women we interviewed, some endured 60 days of rape. The rapes were also accompanied by mutilation and ablation of genital organs. The introduction of sharp and damaging objects or liquids, such as bayonets, knives, tree trunks, boiling water, acid, etc., into the genital organs expressed a hatred and a furious determination to destroy women, to a degree never seen before in that society.

Sexual violence was integrated into a strategy aimed at destroying an ethnic group. As noted by Alison Des Forges, (36) in several localities such as Taba (37) and Kabyayi, political and military authorities organized and supervised the rapes.

Everyone was aware that HIV prevalence was high in urban centres (18%). It was in these centres that the majority of women from the hills gathered, hoping to find protection, and where they were raped. It is clear that the rape would have the murderous consequence of infecting its victims with HIV/AIDS.

Of the 18 interviews conducted as part of the study, only one proves that the rapist had the intention of slowly killing his victim by giving her HIV/AIDS [translation]: “I was raped by two gendarmes …one of the gendarmes was seriously ill, you could see that he had AIDS, his face was covered with spots, his lips were red, almost burned, he had abscesses on his neck. Then he told me ‘take a good look at me and remember what I look like. I could kill you right now but I don't feel like wasting my bullet. I want you to die slowly like me'…” (38)

Proving that these women were infected during the rapes is far from an easy task, especially given that this study is conducted ten years after the genocide. Some facts, such as the abnormally high incidence of HIV/AIDS among women who were raped during the genocide and that the rapists did not wear condoms, show that these organized rapes were, for the majority of victims, vectors of HIV/AIDS. The similar testimony of victims interviewed in Kigali, Taba, Butare and Cyangugu, as well as that taken by telephone in Ruhengeri and Nyanza, led us to conclude that they were infected with HIV/AIDS during these rapes.

Indicators of HIV/AIDS Transmission Through Rapes Carried Out During the Genocide

The abnormally high incidence of HIV/AIDS infection among women raped during the genocide

The official rate of HIV/AIDS prevalence in Rwanda is 13.5%. UNAIDS estimates that out of 500,000 people living with HIV/AIDS in Rwanda , 250,000 are women. (39) With regard to the statistics that demonstrate an equal distribution of HIV/AIDS prevalence among men and women, we must conclude that there is a particular explanation for the fact that women raped during the genocide have a rate of HIV/AIDS infection of between. 66.7% (40) and 80% (41)

According to the Rwandan National AIDS Control Commission, tests performed on 100,000 prisoners linked to the genocide indicate that 13,000 of them, or 13%, are HIV-positive. That rate is identical to the national rate of HIV/AIDS prevalence cited above. The disproportionate level of infection in women who were raped compared with the rest of Rwanda's population can only be explained by the sexual violence inflicted on them.

The Rwandan National AIDS Control Policy states that, through population movement, the war has considerably changed the repartition of HIV/AIDS in the regions. (42) At first, it was an urban phenomenon with around 18% HIV/AIDS prevalence in 1986, while it was 1.3% in the countryside. HIV/AIDS has now become a homogeneous phenomenon affecting urban and rural areas proportionally. In 1997, three years after the genocide, when HIV/AIDS was showing a downward trend in urban areas (at 11.6%), it had climbed in rural regions to 10.8% of the population. The same document recognized that the socio-political crises (43) in Rwanda were often accompanied by violence against women, of whom some were infected with sexually transmitted infections and HIV/AIDS.

If we consider the barbaric manner in which the rapes were committed, barbarism that lasted weeks and even months and that included mutilations and ablation of female genitalia, and if we admit that sexually transmitted infections and other injuries to women's genital organs increases the risk of HIV/AIDS by more than five to ten times, (44) it is understandable why the women who were raped have such a high rate of HIV/AIDS.

The Incubation Period

Out of 18 women interviewed, (45) only four showed signs of the disease between 1995 and 1998. The 14 other women took screening tests between 1999 and 2003 when certain signs of HIV/AIDS began to appear.

These facts reveal two things. Firstly, women underwent screening when they began to notice the first signs of AIDS. In Cyangugu, women who were raped during the genocide and who are living with HIV/AIDS have created a subgroup of AVEGA, called Duhozanye. (46) Of 75 women who were raped, voluntary screening performed between 2001 and 2003 has revealed that, to date, 30 of them are HIV-positive. According to the group's President, not all of the 75 women have undergone screening and, if the association had the means to reach more women, the number of HIV-positive women could still increase. (47) In fact, only rape survivors living in areas close to the urban centre have been reached. This situation is similar to that of a group of HIV-positive women in Kagagu, coordinated by the Rwanda Women's Network, and a group of HIV-positive women in the district of Save, coordinated by the Duhozanye Association of Butare.

Secondly, 1998 marked the end of the period of doubt and the beginning of knowledge of HIV/AIDS status. The first four years after the genocide, during which the women did not experience HIV/AIDS-related health problems, corresponds to the incubation period of three to ten years established by the WHO and UNAIDS, and also explains the exponential increase in signs of HIV/AIDS in rape survivors as of 1998.

Rape-Related Health Complications

Injuries and trauma related to the rapes committed during the genocide are indescribable because of the unparalleled levels of violence. Ten years after, women are unable to speak about it without screaming out in pain and disgust. All the victims have talked about the fact that the severity of the injuries, ablations and other mutilations were such that they would never have lived if at that time they did not have healthy immune systems. Therefore, they could not have had HIV/AIDS before the rapes, as their immune systems would already have been compromised.

Many women died during the period of the genocide, victims of rape and other physical violence committed against them. We will never know their exact number. Others died from the same causes after the genocide. According to AVEGA, at least 200 (48) members of the association have died of AIDS since 2001.

Children Born Before the Rapes

Of the 18 interviews conducted, 13 women were with mothers who had children before the genocide, one had just given birth, two were young single women and two were minors at the time of the genocide.

All the women who were mothers before being raped and who are living with HIV/AIDS today, state that before the genocide they had given birth to healthy babies. They also state that if they had been affected with HIV/AIDS before the genocide, their babies would not have been healthy. In fact, before the introduction of PMTCT (Preventing Mother-to-Child HIV Transmission) treatment, the risk of infection from mother to child was very high.

It is true that the data compiled by UNAIDS, UNICEF and WHO indicate that in Kigali in 1988, 32% of pregnant women aged between 20 and 24 were HIV-positive, while outside of Kigali the level was assessed at between 8% and 10%. (49) Those statistics lead us to believe that it is more probable that women who were pregnant before the genocide and living outside of Kigali contracted HIV/AIDS through the sexual violence committed during the genocide.

Age at Which Some Women Were Raped

Four of the women interviewed were very young at the time of the genocide. They were virgins, and the brutal rapes committed during the genocide were their first “sexual experiences.” Two of them went further in their testimony, stating that after the trauma of the rapes they have never been with another man. They wonder how they could have been infected with HIV/AIDS if it wasn't through rape.

To this category we could add that of women who were relatively older, and who are not generally considered to be at risk, according to the criteria of sexual activity. In Cyangugu, (50) the cases of Immaculée and Thérésie, who died of AIDS last year, aged respectively 57 and 67, who became HIV-positive after having been raped, indicate that rape was the origin of their disease.

Why Did the Rapists Not Use Condoms?

With the exception of one case, all the victims that we spoke with told us they were raped by several men at a time and over several days. None of the men used condoms. The women's testimony is much the same as that of witness J.J. in the Akayesu trial. In the ICTR ruling against Akayesu, the court recognized that rape and sexual violence constitute a crime of genocide. The witness J.J., testified that out of four rapists, only one used a condom. Foregoing condom use was not a common practice. It is highly probable that the average Rwandan, whether peasant, businessperson or soldier, was aware of HIV/AIDS, how it is contracted, transmitted and how to prevent it.

Education and prevention programs were regularly aired on the national radio station, so much so that according to Braeckman, (51) Rwanda was even considered as a “posterchild” in the struggle against HIV/AIDS. In this African country, having a radio and listening to it almost religiously is part of popular culture.

Unless one wanted to die, how could one participate in a gang rape and even individual rape without protecting oneself? A woman who was violated for 60 days by a horde of bandits, soldiers and militia men, asked how a man who had no doubts about his health could participate in such an ignoble act. (52)

Statistics Don't Tell the Whole Story

The indicators described in the previous paragraph, establishing a link of cause and effect between the rapes committed during the genocide and the infection of rape victims with HIV/AIDS, are not exhaustive. The intention is not to scientifically prove this link but to demonstrate by a balance of probabilities that the link exists and that it is the responsibility of an institution such as the ICTR to assist these women victims.

During a meeting on HIV/AIDS and its gender-based implications, the former gender advisor to the ICTR Registrar, Françoise Ngendahayo, (53) noted that many victims had died before testifying and others were too sick to participate in trials at the ICTR. The advisor also noted that in offloading its function vis-à-vis witnesses and victims, the ICTR has found itself in a situation in which victims and survivors have been, in fact, left to their own devices. She therefore pleaded for a perspective of justice, which, without getting involved in humanitarian assistance, would extend into the five areas, (54) including medical and psychological assistance. Such a vision has the goal of ensuring physical, psychological and social rehabilitation for witnesses, particularly victims of sexual violence and HIV/AIDS.

It is from this perspective that a “programme of assistance for witnesses and potential witnesses” was launched in Taba in 2000, by the former Registrar of the ICTR, Agwu U. Okali. In his inaugural speech, the Registrar stated that, in the future, international criminal justice would have to move towards restitutive justice, with the objective of re-establishing the victim in her situation before the violation took place, based more on the needs of the victim than on the guilt or innocence of the accused. (55)

Despite the nuance established by Agwu Okali, that this programme would not be a programme of economic and social assistance for all Rwandan people, any more than it would be a compensation programme, (56) Jean-Paul Akayesu's lawyers decided to contest its rationale for existence. In a letter dated October 2, 2000, addressed to Agwu Okali, John Philpot and André Tremblay, (57) Akayesu's lawyers, severely criticized the Registrar for several aspects of the initiative, notably the fact that the ICTR did not have the legal mandate to carry out a programme of restitutive justice and that the neutrality of the Registrar was compromised.

The response of the Registrar, speaking of the programme of assistance for witnesses, was based on article 21 of the ICTR Statute and rule 34 of the Rules of Procedure and Evidence, which, as we will see later, authorizes the provision of support to victims and witnesses for their physical and psychological rehabilitation. With respect to neutrality, the Registrar stressed that neutrality does not mean passivity or the absence of action, any more than impartial services “means no services to anyone.” (58)

Managed by the victims and witnesses assistance section, the programme's budget, according to the International Crisis Group, (59) was US$379,000 in 2000, with US$300,000 coming from the ICTR Volunteer Trust Fund, and was shared among several women's organizations in Rwanda: the Rwanda Women's Network, the Association sociale des femmes rwandaises [Rwandan women's social association], Pro-femmes, Haguruka and AVEGA-AGAHOZO.

Nevertheless, although it is innovative, and part of it is dedicated to medical assistance, the programme has not responded to the fundamental need of women witnesses and victims for access to HIV/AIDS treatment. The amounts received were so meagre that they did not even provide access to antibiotics to heal opportunistic infections. (60) The issue of HIV/AIDS treatment remains completely unresolved. One of the principal tests for justice is its ability to adopt reparation measures that, without limiting their scope, guarantee the right to HIV/AIDS treatment for victims of sexual violence.

The need for justice and reparation

The addition of HIV/AIDS to the consequences of the rapes committed during genocide reconfigures the perception of justice and requires entitlement to physical rehabilitation, because, in the absence of antiretroviral treatment and other consequential care, the survivor-victims are virtually sentenced to death.

Enter the right of victims to a remedy for reparation, which is a well-established principle of international law that is recognized in the provisions of many treaties as well as by the courts. In traditional law, the State is liable for reparation of damages caused by a violation of international law. (61) Thus, where a State violates its international obligations and where that violation causes damages to a third party, that State is liable for reparation of the damage caused. The International Court of Justice, created under the Charter of the United Nations, has recognized that the principles of State liability allow the courts to grant compensation to a State on behalf of its nationals who sustain damages caused by another State. (62)

The Sub-Commission on Prevention of Discrimination and the Protection of Minorities, the principal subsidiary organ of the United Nations Commission on Human Rights, is currently formulating the rights of victims to institute actions for reparation for violations of international law. Basic Principles and Guidelines on the Right to Remedy and Reparation for Victims of Violations of International Human Rights and Humanitarian Law are in the process of being drafted. This document defines the mechanisms, terms and conditions, procedures and methods for performance of legal obligations currently in force under international human rights and humanitarian law. These principles and guidelines are based not only on notions of State liability but also on the relatively recent concept of “human solidarity with victims, survivors and future human generations.” Thus, the right of victims to reparation has been broadened in relation to the concept of State liability. A government could be called upon to directly assist the victims of such violations even if it has no liability with respect to those particular violations.

Developments in international law in favour of victims' rights are also confirmed by article 75 (2) of the Rome Statute, which allows the International Criminal Court to make an order against a convicted person specifying an appropriate amount of monetary compensation, appropriate reparations and rehabilitation.

Like the Statute of the International Criminal Tribunal for the Former Yugoslavia(ICTY), the Statute of the ICTR allows for only one form of reparation, namely material restitution. If the Tribunal “… finds the accused guilty of a crime and concludes from the evidence that unlawful taking of property by the accused was associated with it, it shall make a specific finding to that effect in its judgement ” and can order the restitution of that property. (63) However, the material restitution is only one form of the right to restitution and the Statute of the ICTR is limited in that respect. (64) Wherever possible, restitution should restore the victim to her original situation before the violation took place. (65) For a victim of sexual assault, especially those who have contracted HIV/AIDS, restoration to her pre- violation situation is impossible. It is therefore important to note that there are other forms of reparation and that in international law, victims of gross violations of human rights and serious violations of humanitarian law should, as appropriate, and in proportion to the seriousness of the violation and the circumstances of each case, be assured full and effective reparation in all its forms namely, restitution, compensation for all financially quantifiable damages, rehabilitation, satisfaction (66) and assurance of non-repetition, and prevention of recurrence. (67)

In the context of extreme poverty, as is the case in Rwanda, and in the face of crimes which, like sexual assault causing HIV/AIDS, have caused physical and psychological damage resulting in death, victims should be entitled to avail themselves of the clearly stated principle that “rehabilitation should include medical and psychological care as well as legal and social services.” (68) The December 2002 report on the consultations organized on this subject concluded as follows: “The need for victims, many of whom come from the least-resourced sectors and groups of society, to be afforded medical, psychological, legal and social services… was seen to be crucial.” (69)

The majority of women living with HIV/AIDS are indigent. For those among them who make their living from agriculture, their monthly income is estimated at less than US$10. Faced with a national triple therapy access program, the treatment capacity of which will not exceed 7000 by 2006, these women's chances for eligibility are very poor. It is therefore a matter or urgency to find mechanisms for justice and social rehabilitation that take account of this specific feature.

Therefore, for women living with HIV/AIDS, entitlement to rehabilitation should include not only access to psychological services and triple therapy, among other medical treatments, but also access to a social worker who could counsel them and help them manage the consequences of sexual violence and genocide, such as depression and loss of autonomy. On the other hand, their entitlement to compensation should provide a means for dealing with the socio-economic consequences of violence, such as loss of family income and reduced productivity, thereby enabling them to pay for such things as their children's school fees and rent.

The right of the victims to obtain satisfaction includes legal sanctions for the crimes of sexual violence committed in connection with the genocide, for example the decision rendered by the ICTR in the Jean Paul Akayesu case, or proceedings before Rwandan courts under the Genocide Act. As regards the ICTR, it is crucial that the Prosecutor's Office ensure that ICTR decisions reflect the range of sexual violence committed in Rwanda, but also that they broaden the definition of crimes of sexual violence so that the many forms of sexual violence inflicted on Rwandan women are taken into account, for example by categorizing sexual slavery (individual or collective) and rape as forms of torture. T he Prosecutor's Office should also attempt to develop a body of case law on the transmission of HIV/AIDS as an element of the crime of rape and a tool of genocide. AVEGA recommends considering the possibility of a class action aimed at managing the care of women who were victims of violence during the genocide and primarily those who are now infected with HIV/AIDS. Entitlement to satisfaction would be connected to entitlement to rehabilitation, because in order to initiate a class action before the Rwandan courts or elsewhere, the women must be ensured of having legal advisors assigned to them. Lastly, in order to provide assurances of non-recurrence and prevention, the Rwandan government should train the staff responsible for the administration of justice and public security (law enforcement, the military) on the rights of women and on crimes of sexual violence in order to put an end to impunity for such crimes and provide justice to women.

The women who testified in connection with this study were unanimous in their condemnation that justice has ignored them. They question the morality of the ICTR feeding and caring for their assailants, while they are left to die in total indifference.

These women are living in the corridors of death. Through their testimonies they pay homage to the high numbers of women who were living in the same conditions and who have already died from HIV/AIDS. In Cyangugu, eight of the 30 members of Duhozanye (an AVEGA-affiliated association of women raped during the genocide and living with HIV/AIDS) died in 2003. At this pace, none of the others will be alive in three years.

Regardless of where they live, Butare, Taba or Kagugu, the testimony of the members of ABASA, SEVOTA and the Rwanda Women's Network reveals the extent to which raped and infected women are dying of HIV/AIDS. The mortality rate among those women is so high that the little funds they can raise must be divided between the costs of hospitalization and the purchase of coffins.

With the realization that they have been forgotten, many of them readily say that they no longer consider themselves part of this world and that they did not testify for themselves, but for their children so that one day they will know that many women were killed and that humanity turned its back. In such a context of denial of justice, it is of the utmost urgency that the ICTR, the Rwandan Government and international cooperation agencies work together to find sustainable solutions if they are to be truly regarded as survivors.

Medical Assistance for Witnesses and Victims Provided by the International Criminal Tribunal for Rwanda

The ICTR is governed by a statute and regulations that allows the Registrar's Office to grant the assistance necessary for the physical and psychological rehabilitation of witnesses and victims. On one hand, article 21 of the Statute of the ICTR, pertaining to the protection of witnesses states “the International Tribunal for Rwanda provides in its rules of procedure and evidence measures for the protection of victims and witnesses. The protection measures include, without limitation, (70) the holding of closed hearings and the protection of victims' identities.” However, rule 34 of the Rules of Procedure and Evidence explicitly states as follows:

A) There shall be set up under the authority of the Registrar a Victims and Witnesses Support Unit consisting of qualified staff to:

1. recommend the adoption of protective measures for victims and witnesses in accordance with Article 21 of the Statute;
2. ensure that they receive relevant support, including physical and psychological rehabilitation, (71) especially counselling in cases of rape and sexual assault; and
3. develop short term and long term plans for the protection of witnesses who have testified before the Tribunal and who fear a threat to their life, property or family.

Thus, the entitlement of victims and witnesses to the support necessary for their physical rehabilitation is granted by the Registrar's Office without regard to the criminal liability of an accused.

So that rule 34 can be applied, the ICTR produced and provided the VWSU (Victims and Witnesses Support Unit) with a Manual of Operational Guidance. Based on the challenges specific to the Rwandan genocide, the manual recommends several alternatives that could help to alleviate the life-long consequences of rape and sexual assault. (72) In the paragraph pertaining to physical assistance and psychological rehabilitation of victims of rape and sexual assault, the Manual of Operational Guidance states that it is crucial for a special program to be created within the VWSU to respond appropriately to the needs of survivors and witnesses. (73) The document further stipulates that the VWSU must provide medical and psychological services in strict confidence to the victims and the witnesses who, because of the genocide, are seriously traumatized or have contracted illnesses that they were unable to recover from before testifying. (74)

As seen earlier, the ICTR has all the legal tools to ensure that triple therapy is provided to those witnesses and victims in need of it. Nowhere in the ICTR's own documents is there a stated hierarchy of medical needs for the witnesses and victims. At issue are illnesses and traumas that are the result of rape and other forms of sexual assault, without any distinction.

However, six of the 18 women interviewed individually for this study, 6 testified before the ICTR or provided information in an investigation conducted by the Prosecutor's Office in Rwanda, but only three of them received triple therapy from the ICTR. Two of the other six had their requests refused and one said it was not worth the trouble to ask for triple therapy from the ICTR, because it had already refused to provide the treatment to other women with HIV/AIDS who testified.

It is astounding that the ICTR agrees to defray the costs related to all other illnesses from which these women suffer, but vacillates when it comes to HIV/AIDS. The women who testify in court are treated for things such as opportunistic infections, gynaecological complications and psychological trauma. HIV/AIDS intersects all these ills.

According to unofficial explanations by ICTR representatives, refusal to provide triple therapy to the victims would be based on three main reasons, namely the ICTR's mandate, its credibility vis-à-vis the defence and the lack of evidence linking sexual violence to the HIV/AIDS status of the victims.

Respecting ICTR Medical Care of Witnesses, Including Access to Triple Therapy

The ICTR has the power to use Rule 34 of its Rules of Procedure and Evidence to ensure that witnesses and victims receive HIV/AIDS treatment. In September 2000, in a public announcement (75) concerning implementation of its restitutional justice project, the ICTR stated that this new way of approaching justice included medical assistance for victims and witnesses, the majority of whom were sexually assaulted during the genocide. In response to the comments of the attorneys for Jean-Paul Akayesu to the effect that the Statute of the ICTR did not sanction such a programme and that the neutrality of the Registrar was compromised in such circumstances, the former Registrar, Agwu Okali, justified the assistance programme for witnesses and potential witnesses by invoking Rule 34.

In 2002, on the advice of the United Nations Office of Legal Affairs in New York, the programme was the subject of reorientation: The Court “… will now provide legal, psychological and medical assistance to witnessestestifying before the Tribunal.” (76) This interpretation of Rule 34 ensured that the Court would no longer provide assistance to victims who were not called to testify. However, the testimony obtained in connection with this study, reveals the tendency of the Court to back-peddle when it comes to the right of witnesses to have access to triple therapy. According to the Court, the medical assistance provided to witnesses does not include access to triple therapy because HIV/AIDS in an incurable disease and when the Tribunal's mandate ends in 2010, (77) the ICTR would not be able to continue to provide HIV/AIDS treatment.

The creation of the Victims and Witnesses Support Unit(VWSU) constitutes a precedent (78) in the history of the United Nations, because the UN realized that it was necessary to meet the particular needs inherent in the issues involved in the Rwandan and Yugoslavian situations. Furthermore, the operations of the ICTR's VWSU differ from those of the ICTY because of the specific problems posed by the Rwandan genocide. (79) Thus, as HIV/AIDS is a pandemic and Rwandan genocide accelerated the spread of HIV the disease, it is all the more crucial that the VWSU address this issue so as to provide justice to Rwandan victims of rape and other sexual assaults. In light of the serious consequences such as failing health, loss of autonomy and depression caused by rape and HIV/AIDS, it is essential for the women who testify before the ICTR to have access to antiretroviral treatment.

Further, only a handful of women raped during the Rwandan genocide testified before the ICTR. The argument to the effect that there would have been a rush of witnesses seeking HIV/AIDS drugs were the ICTR to grant the victims and witnesses access to HIV/AIDS treatment, is unfounded. Not all women who were raped contracted HIV/AIDS and not all women living with HIV/AIDS meet the criteria for being witnesses. Moreover, the fact that the women persisted in testifying, despite the refusal of the ICTR to grant antiretroviral treatment to the majority of them, implies that their primary motivation for cooperating with the Tribunal was not access to treatment, but the search for the justice. If the ICTR provided care and services other than triple therapy to the witnesses and victims and if the defence were amenable, the defence's objection to witnesses and victims receiving triple therapy no longer has any basis. It is a fact that the ICTR provides alleged genocidaires with access to antiretroviral treatment. The experts formulating the right to reparation observed that victims were “…often treated by legal systems with less dignity and compassion than perpetrators.” (80) The ICTR should therefore not use the excuse that it will attract criticism from the defence as grounds for denying the same right to the victims, i.e., access to antiretroviral treatment, that it grants to the accused. It is the ICTR's responsibility to decide the issue of access to HIV/AIDS treatment because even in restricting its mission to simply trying the accused, accomplishment of that mission is inconceivable without witnesses. It is therefore in the interests of the Prosecutor's Office of the Tribunal to preserve the health of witnesses.

In its last annual report, the ICTR announced that the Registrar had “recently recruited three medical experts for ICTR in Kigali, comprising a gynaecologist, a psychologist and a nurse - psychologist, to improve access to and monitoring of medical support for victims and witnesses, including in relation to the management of HIV/AIDS.”  (81) This recent initiative is positive and we trust that it presages a policy change regarding the Court's medical management of witnesses and victims of sexual violence who have HIV/AIDS.

The Court cannot hide behind the terms of its mandate to explain its refusal to allow access to HIV/AIDS treatment. The Voluntary Trust Fund created by Resolution 49/251 of July 20, 1995 of the UN General Assembly, is a fund with an unlimited term. Supplementing the regular budget of the ICTR, the fund is oriented towards financing the activities of several key sectors, including the Victims and Witnesses Support Unit. If it were to be better endowed, it would guarantee the long-term needs of witnesses and victims (82), including for HIV/AIDS treatment. It is therefore of paramount importance that the Fund's budget be applied, on a priority basis, to achieving that objective, and that the Registrar's Office adopt a strategy to convince States to increase their monetary contributions.

Compensation of Victims of the Rwandan Genocide by the ICTR

The Tribunal stated its position regarding the broader principle of compensation of victims as follows: “The Tribunal agrees with the principle of compensation for victims, but […] under the terms of its Statute, it cannot meet this expectation and that the subject of compensation to victims can be more appropriately addressed by the international community in general and by the Security Council in particular. ” (83)

This interpretation of the ICTR's mandate is a restrictive vision of the concept of justice and indicates a lack of commitment to the question of the reparation of Rwandan victims. Although the Basic Principles and Guidelines on the Right to a Remedy and Reparation for Victims of Gross Violations of International Human Rights Law and Serious Violations of Humanitarian Law are still in the process of formulation, the ICTR nevertheless had the latitude to use the Basic Principles and Guidelinesto interpret its mandate regarding the compensation of victims. Intended on a priority basis for States and non-State participants, the principles could be applied by any other institution responsible for administering justice. In raising the right of victims to a remedy and reparation based on social and human solidarity, (84) the principles allow for innovation by extending the notion of reparation beyond the determination of criminal liability. Thus, as an international institution, whose mandate is to obtain justice for the victims of Rwandan genocide, the Court should develop a strategy for compensating victims and their dependants, in collaboration with the United Nations, the Rwandan government and members of the international community.

As the 8 th Annual Report of the ICTR states, creation of a special Trust Fund for the victims of genocide in Rwanda would be desirable as would be the creation of an advisory group responsible for finding the ways and means to ensure that sustainable rehabilitation of witnesses and victims survives termination of the Court's mandate. (85) The idea of creating such a fund is supported by many NGOs and prominent people. It has been defended by Ms. Najat Al Hajjaji, (86) President of the 59 th Session of the UN Commission on Human Rights, as well as by the International Crisis Group. (87) It is essential that the Fund take into account the needs of witnesses and victims of sexual violence who have contracted HIV/AIDS as a result of such acts. There is an urgent need to create this fund to benefit the women survivors of genocide who are living with HIV/AIDS, before they die.

Creation of the fund is all the more important given that Rwanda is one of the ten poorest countries in the world and that 60% of its citizens live on less than one dollar a day. There is very little likelihood that the victims and witnesses living with HIV/AIDS will be cared for by the Rwandan health care system. The only procedure created by the Rwandan government to help the survivors of genocide is the Fonds d'aide aux rescapés du génocide (FARG) [genocide survivors' assistance fund]. Victim support provided by the Rwandan government is estimated at 5% (88) of its national annual budget. Inspired by the right to reparation, specifically by the need for States to create national victims' compensation funds, as recommended by the United Nations Commission on Human Rights, (89) the FARG covers several basic needs, including providing schooling for orphans and lodging for widows. It does not ensure universal access to health care, never mind access to HIV/AIDS treatment.

The issue of material compensation of victims by the Rwandan courts is not related to a mandate but rather to financial means. In 2001, the International Crisis Group estimated that after only 4000 persons were prosecuted and judged, the Rwandan courts granted close to US$100 million in damages to victims. However, not one cent has been paid out, the principal reason being the indigence of the accused. (90)

If the ICTR adhered to Rule 106 (91) of its Rules of Procedure and Evidence, which recognizes the entitlement of victims to compensation but at the same time discharges it from performing this responsibility by referring the victims to a forum of national jurisdiction or any other institution of competent jurisdiction for reparation, the cases where victims requiring psycho-medical care would have their rights respected in connection with compensation are rare, even non-existent. Where the persons found guilty by the ICTR are not indigent, it is the responsibility of the Victims and Witnesses Support Unit, according to Rule 34 of the Rules of Procedure and Evidence, to provide advisory services, which in this case could result in initiating legal proceedings to obtain compensation in Rwanda or elsewhere should the possibility arise.

Recommendations to the ICTR

• The ICTR should, as a matter of urgency, adopt a policy on access of victims and witnesses to antiretroviral treatment and related care. To do this, it should comply with the following:
• the recommendations set forth in the Manual of Operational Guidance, especially as regard to interpreting the mandate of the Victims and Witnesses Support Unit, which explicitly addresses support to rape victims and sexual assault in terms of physical and psychological rehabilitation; (92)
• the main features of the assistance program for witnesses and victims, as targeted by the Manual of Operational Guidance, which specifically include medical services;
• Rule 34 of the ICTR's Rules of Procedure and Evidence, which recommends that victims and witnesses be provided with the assistance necessary for their physical and psychological rehabilitation, in particular through advice and counselling in the case of rape and sexual assault;
• the UN's draft Basic Principles and Guidelines on the Right to a Remedy and Reparation for Victims of Gross Violations of International Human Rights Laws and Serious Violations of Humanitarian Law. These principles concern the reparation of physical or moral damage and call for medical and psychological care of victims as well as access to legal and social services.



• The investigation team of the ICTR Prosecutor's Office, specifically the gender crimes unit, should conduct a detailed investigation into the relationship between HIV/AIDS and the sexual violence and use the results of the investigation to develop a body of case law on the transmission of HIV/AIDS as a weapon of genocide.



• The ICTR should adopt measures so that on termination of its mandate, some other umbrella organization that includes international, bilateral or multilateral organizations like WHO, UNAIDS, the UNDP, the European Union or the African Union, take over the medical care of victims and witnesses, as well as persons approached by the prosecution in the investigation phase who were called to testify. To do this, the Registrar's Office should adopt a strategy of asking States to increase their voluntary monetary contributions to the Fund.



• Compensation of the victims of Rwandan genocide and their dependents can be assured by a Trust Fund for assistance to victims. It is important and urgent that the ICTR approach all UN member countries and financial donors, in order to create such a fund.

The Role of the Rwandan Government

To replace old structures designed to battle HIV/AIDS, a National AIDS Control Commission was created in November 2000, with its principal task being to provide the country with a national HIV/AIDS policy. The 2002-2006 National Strategic Framework for HIV/AIDS Control as well as the 2002-2004 Multisectoral National Plan created by this Commission are the government's main policy tools.

The national HIV/AIDS control policy was conceived from a gender-based perspective. (93) It is based on five values and guiding principles including equity and respect for gender specificity. Out of five strategic intervention axes of the National Strategic Framework for HIV/AIDS Control, the fourth is “to strengthen measures for poverty reduction and integrate poverty/gender/HIV dimensions in HIV/AIDS control.” The policy also acknowledges that there are substantial differences in the way the pandemic affects male and female populations and that the national response, in its strategies for education, medical care and reduction of the impact of HIV/AIDS, must take gender issues into consideration. (94) In a paragraph on the social impact of HIV/AIDS, the policy clearly states: [translation] “Given that 70% of the women raped during the genocide are HIV-positive, it can be concluded that there is need for the social management of these families and their orphans.” (95)

Lastly, the Rwandan government has agreed to take into account special conditions, including those related to the effects of war and genocide, on women, orphans and other groups considered as being vulnerable. (96)

Inadequacy of Resources

However, the national policy contrasts with the reality of the women encountered in connection with this study, just as it contrasts with the right to health of 13.5% of the Rwandan population living with HIV/AIDS. It should be noted that out of 500,000 people living with HIV/AIDS and requiring triple therapy, only 7000 (97) of them will have access to the therapy by 2006.

Foreign aid accounts for 96% of the Rwandan national budget. In 2000, the net total of public development assistance received by Rwanda was US$322 million. (98) According to the UNDP, 84% of the Rwandan population lives on US$2 a day, with a life expectancy at birth of 40 years.

Such a picture illustrates the operational limits of the government with respect to public spending, including health spending. It also contributes to an understanding of why only an infinitesimal minority of persons with HIV/AIDS benefit from triple therapy. Out of 30 women interviewed for this study, and apart from three whose medication is taken care of by the ICTR, only one has been on antiretroviral treatment for a year, and she pays for it herself. (99)

Rose Mukamusana, (100) the person in charge of the Programme d'appui aux personnes infectées (PAPI) [Support programme for infected persons] managed by AVEGA- AGAHOZO, states that only one out of 30 members of AVEGA have access to triple therapy. Twenty have access through funding by two international NGOs, one British (Surf), and the other Dutch (the Hildegarde Von Bingen Foundation). The ten others have access under a government program. However, at least 800 women who frequent AVEGA- AGAHOZO need access to treatment.

At the Polyclinic of Hope, coordinated by the Rwanda Women's Network, none of the women have access to antiretroviral treatment. Mary Balikungeri, (101) Executive Director, commented on the difficulty of convincing donors to provide antiretroviral treatment. Because of lack of funding, the Polyclinic of Hope can only provide drugs to counter opportunistic infections. Women die because the Polyclinic is powerless. Mary Balikungeri bitterly recounted the frequency with which groups of investigators came to question victims but left without doing anything for them. She emphasized that the greatest danger is to ignore the victims for whom all these investigations were supposedly conducted.

This feeling of discontent has also been expressed by the spokesperson for Duhozanye: [translation] “We are tired of always saying the same thing. We have testified, but no-one has answered our call for help. We have been dropping like flies without anyone coming to our rescue, neither the government, nor the international aid organizations. Many of us have died. We need help now, tomorrow is too late.” (102)

According to the Rwandan policy document on the fight against HIV/AIDS, there is working capital of FRw82 million to make antiretroviral treatment available. (103) Bilaterally, the American, Belgian, Luxembourger, Swiss, French, German, Canadian, British, Italian and European Union cooperation agencies contribute financially to the Rwandan national policy. Multilaterally, UN agencies like UNAIDS, the UNDP, UNICEF, the United Nations Population Fund (UNPF), WHO, United Nations Educational, Scientific and Cultural Organization (UNESCO), the World Bank (WB), the Office of the United Nations High Commissioner for Refugees (UNHCR), the World Food Program (WFP) and the Economic Commission for Africa specifically participate in the Rwandan fight against HIV/AIDS in the form of donations and loans.

Private and humanitarian initiatives also contribute to that struggle, including the following: the Bill and Belinda Gates Foundation , the Clinton Foundation, Care International, the International Committee of the Red Cross (ICRC), FHI/Impact Rwanda, Action Aid, World Relief, the Norwegian Church, Africare and Save the Children. It should also be noted that the Rwandan President's wife, Jeannette Kagame, has set up a fund devoted to the fight against HIV/AIDS. According to UNAIDS, the fund managed by the Rwandan First Lady has a budget of $US750,000 over three years.

These partnerships, while impressive at first glance, must however be analyzed in light of vast HIV/AIDS-related needs. The funds raised are not allocated solely to the purchase of drugs. In a context of post-conflict poverty, HIV/AIDS has many social and economic consequences, including a negative impact on the active population and on productivity, an increase in the number of orphans and a nursing crisis. For this reason, the Rwandan policy, like all policies of African countries dealing with a high incidence of HIV/AIDS, is a global and therefore costly policy, which takes into account the multiple medical, social and economic consequences of the HIV/AIDS pandemic.

All partners, regardless of whether they are private, bilateral, multilateral or humanitarian, choose an intervention sector on the basis of their particular expertise or vocation. Thus, USAID, UNESCO and Swiss cooperation agencies finance HIV/AIDS awareness and prevention activities, particularly among the young. Some, like UNICEF, finance the prevention of mother to child transmission (PMTCT). Others, like the UNDP, fund micro-projects with a view to reducing the socio-economic impact of HIV/AIDS. Lastly, others, like the Office of Rwanda's First Lady, provide assistance to widows and orphans.

Problem of coordination

The increase in donors undoubtedly reflects international HIV/AIDS awareness, but the mobilization of funds is still inadequate to meet needs. It is also important to note that this increase in donors also raises problems of coordination regarding the management of a national fund devoted to the fight against HIV/AIDS.

Even if the National AIDS Control Commission (NACC) has instruments of operationalization, namely the 2002-2006 National Strategic Framework for HIV/AIDS Control as well as the 2002-2006 Multisectoral National Plan, it recognizes that [translation] “the financing of activities focused on controlling HIV/AIDS is operated without transparency and in an unsatisfactory manner.” (104)

Among its weaknesses, the NACC noted the absence of reliable data on the level of contributions and in the choice of strategic orientations and fields of intervention of the many donors even though they have been involved in battling HIV/AIDS for more than a decade. (105)

Regarding the allocation of funds, the NACC notes that the procedure was not harmonized and was poorly documented until 2002, the year it was created. (106) It specifically notes a significant administrative burden and argues in favour of fast-tracking procedures to facilitate access of stakeholders to financing for HIV/AIDS-related projects and the implementation of a review process covering the terms and conditions for funds allocation (107) as well as the creation of the Central Funds Management Unit, (108) an independently managed para-governmental body.

High Costs of Triple Therapy and the Exclusion of Women

Although lack of coordination impedes carrying out the Rwandan plan to fight HIV/AIDS, it is far from being the primary cause of antiretroviral treatment being inaccessible to patients. This inaccessibility is basically related to an inadequacy of resources and to the excessively high cost of triple therapy.

In a document on the use of antiretroviral treatment, Rwanda's Ministry of Health (109) stated that the social constraints and the high costs of the treatment forced it to tighten the eligibility conditions for antiretroviral treatment. Patients whose stage of illness is considered advanced or who present with serious symptoms are considered high priority. It should also be noted that prescriptions for antiretroviral treatment are given solely in the following certified hospitals: the University Hospital in Kigali , the Military Hospital in Kanombe, the King Faycal Hospital in Kigali , the TRAC Referral Clinic and the University Hospital in Butare. (110) Getting to major hospitals is an obstacle for the majority of women with HIV/AIDS, who live in remote areas far from them and who find the costs of medical consultation too high.

A degree of healthy scepticism is in order with respect to the criteria of the Ministry of Health when it explains that [translation] “… socio-economic criteria are key and are positive discrimination criteria and not criteria of exclusion, because the patients' financial participation in the monthly costs of their treatment is mandatory for any patient who does not have a certificate of indigence…” (111)

None of the women interviewed receives antiretroviral treatment from the government. However, with the exception of three witnesses, all are indigent and are cared for by government-recognized women's associations. Out of three women with an income, only one pays for her antiretroviral treatment. In her case, it is at the expense of other basic needs, specifically caring for the ten orphans in her charge. The two other women have paid employment but their incomes are insufficient to defray the costs of antiretroviral treatment.

Recommendations to the Rwandan Government

• The Government should comply with its national HIV/AIDS policy, which recognizes that the women who were raped and who are living with HIV are victims twice over and should receive special attention. To do this, the government should, in collaboration with associations of genocide victims and survivors and bilateral and multilateral partners, formulate a plan of action aimed at providing antiretroviral treatment to women who were raped and are living with HIV/AIDS.



• The government should ensure that women who have a certificate of indigence are eligible for access to the antiretroviral treatment program.



• The Fonds de lutte contre le sida [HIV/AIDS control fund] managed by the First Lady's Office, should, in accordance with national policy principles and orientations and in collaboration with women's associations, ensure that medical care and treatment is provided to the women who were raped and who are living with HIV/AIDS.



• The government should ensure that women living in regions far from urban centres benefit from all services, including HIV/AIDS treatment and access to antiretroviral treatment.

Humanitarian Organizations and International Cooperation

Doctors without Borders

In a context where the majority of the population and 82% (112)of the women are faced with problems of accessibility to health centres and health care, it becomes urgent to increase cooperation initiatives like those initiated by Doctors without Borders. Moreover, this incidence (82%) is concordant with the AVEGA- AGAHOZO study on violence against women, which indicates that in 1999, only 6% of the women questioned had consulted a doctor since the genocide and 71% of the victims desired medical assistance. (113)

Médecins sans Frontières [Doctors Without Borders]- Belgium conducted two projects in Rwanda , providing HIV/AIDS treatment without the need for sophisticated infrastructures. Two public health centres in Kinyinya and Kimironko are currently operational, and another one in Kagugu is on the verge of being operational. These three health centres cover 22% (114) of the total population of Kigali, namely 132,812 residents out of a total of 609,000.

Pursuant to an agreement signed with the Ministry of Health, MSF-Belgium has undertaken to provide antiretroviral treatment and medical care to 500 persons over five years. In an interview we had with Ms. Helena Hellqwist, (115) attending physician at the Kimironko Centre, she stated that the frequently cited problem of lack of infrastructures and equipment is not a genuine problem. She adds that pilot projects like that in Kimirinko, show that with a little more commitment, accessibility to antiretroviral treatment can be increased. The experience of these pilot projects show that the local paramedical staff working in public health centres are fully equipped to meet the challenge. The major problem is the funding of such projects.

Recommendations to Humanitarian and International Cooperation Agencies (116)

• Finance more projects devoted to strengthening the operational capacities of health centres. The more the health centres develop a program of medical care for persons with HIV/AIDS, the better will be the chances for women to receive care.



• Throughout the entire country, carry out initiatives like those of Doctors Without Borders, which work in cooperation with certified health centres. The more numerous the health centres that dispense the triple therapy, the higher the numbers of women that will be reached.



• Increase and/or start HIV/AIDS treatment funding projects. The women encountered are members of groups of genocide widows or survivors. For SEVOTA, the Rwanda Women's Network, AVEGA, ABASA or Duhozanye, the lack of funding for HIV/AIDS treatment considerably handicaps survival of the victims.



• Integrate access to antiretroviral treatment in development or anti-poverty projects. It is important that international solidarity NGOs incorporate the problem of HIV/AIDS in their work.

Coalition for Women's Human Rights in Conflict Situations (117)

• The Coalition should encourage its members and the NGOs working in related fields to conduct more research with a view to building a body of case law on the issue of reparations in relation to wartime rape and HIV infection.



• The Coalition, in collaboration with Rwandan women survivors groups and other associations concerned with the rights of women who testify before the ICTR, should ensure that the ICTR fully respectsthe rights of victims and witnesses to physical and psychosocial rehabilitation.



• The Coalition should form a committee to follow up the recommendations put forward in this study. Such a committee should be comprised of persons from the international movement for access to triple therapy, international organizations like Amnesty International and Human Rights Watch, which are focused on the Rwandan situation, and Rwandan women's associations concerned with the issue of rape and HIV/AIDS.



• The Coalition should develop an advocacy strategy and contact multilateral and bilateral agencies for a response to the issues raised in this study.

Rwandan Women's Rights Associations

• As AVEGA-AGAHOZO suggested in its study on violence against women, a class action lawsuit to ensure [our translation] “medical care of women who were victims of violence committed against them during the genocide and especially the care of women infected with HIV/AIDS” (118) is an idea that merits consideration by the Rwandan courts and the ICTR. Using that study and recent reports written on this topic by Save the Children, Amnesty International, and African Rights provide the momentum to apply to the Rwandan courts.



• The women raped during the genocide and living with HIV/AIDS and supported by Rwandan women's rights associations should organize into a National Committee and demand that, in accordance with its national policy, the Rwandan government ensure their access to medical care, specifically access to antiretroviral treatment.



• Associations of genocide survivors and widows should provide information to indigent women members so that they can benefit from the national program for access to antiretroviral treatment.

Endnotes

     1) United Nations, Economic and Social Council, Towards an effective implementation of international norms to end violence against women, Report of the Special Rapporteur on violence against women, its causes and consequences, E/CN.4/2004/66, December 26, 2003 , p. 15.   Return

     2) AIDS, or acquired immunodeficiency syndrome, is a disease caused by a virus that attacks the immune system (the body's natural defence system). Scientists have named the virus HIV (human immuno-deficiency virus).   Return

     3) Jean Pierre Chrétien, Le défi de l'ethnisme, Karthala, 1997, pp. 91-99.   Return

     4) AVEGA-AGAHOZO, Étude sur les violences faites aux femmes, 1999, p. 33.   Return

     5) Save the Children, HIV and conflict: a double emergency, 2002, p. 5.   Return

     6) United Nations, Economic and Social Council, Report on the situation of human rights in Rwanda submitted by Mr. R. Degni-Séqui, Special Rapporteur of the Commission on Human Rights, under paragraph 20 of Commission resolution E/CN.4/S-3/1 of 25 May 1994 , E/CN.4/1995/7, 28 June 1994 .   Return

     7) United Nations, Security Council, Letter dated 1 October 1994 from the Secretary General addressed to the President of the Security Council, S/1994/1125, 4 October 1994 , points 124 and 133.   Return

     8) United Nations, Economic and Social Council, Report on the situation of human rights in Rwanda submitted by Mr. René Degni-Ségui, Special Rapporteur of the Commission on Human Rights, under paragraph 20 of resolution S-3/1 of 25 May 1994 , E/CN.4/1996/68, 29 January 1996 , points 16-20.   Return

     9) Ibid.   Return

     10) African Rights, Rwanda, Death, Despair and Defiance, September 1994, p. 448.   Return

     11) Human Rights Watch/FIDH, Shattered Lives: Sexual Violence during the Rwandan Genocide and its Aftermath, 1996.   Return

     12) United Nations, Economic and Social Council, Report of the Special Rapporteur on violence against women, its causes and consequences, Ms. Radhika Coomaraswamy , Addendum, Report of the mission to Rwanda on the issues of violence against women in situations of armed conflict , E/CN.4/1998/54/Add.1, 4 February 1998.   Return

     13) Ibid., point 31.   Return

     14) Ibid., point 32.   Return

     15) Ibid., point 84.   Return

     16) See Appendix: Testimony of women who were victims or rape and HIV/AIDS during the Rwandan genocide   Return

     17) Interviews, Kigali, February 11, 2004.   Return

     18) Also referred to as antiretroviral treatment.   Return

     19) Amnesty International, Rwanda: “Marked for Death”, rape survivors living with HIV/AIDS in Rwanda, 2004.   Return

     20) National AIDS Control Commission (NACC), 2002-2006 Rwandan National Strategic Framework for HIV/AIDS Control, November 1, 2002, p. 55.   Return

     21) Ibid.   Return

     22) This estimate was established by Godeliève Mukasarasi, president of SEVOTA.   Return

     23) Interviews with Godeliève Mukasarasi, Taba, February 16, 2004.   Return

     24) AVEGA-AGAHOZO, op. cit., note 4.   Return

     25) Ibid, p. 33.   Return

     26) Save the Children, op. cit., note 5.   Return

     27) Amnesty International, op. cit., note 19.   Return

     28) African Rights, Broken bodies, torn spirits: living with genocide, rape and HIV/AIDS, 2004.   Return

     29) Jean-Pierre Chrétien, op. cit., note 3.   Return

     30) HRW/FIDH, Leave None to Tell the Story: Genocide in Rwanda, March 1999.   Return

     31) Jean-Pierre Chrétien, (under the direction of), Rwanda. Les medias du genocide, 1995, p. 7.   Return

     32) The HRW report, that of the Special Rapporteur on Violence Against Women, Its Causes and Consequences and the AVEGA-AGAHOZO study all referred to these commandments, particularly the first three related to Tutsi women. For a detailed analysis of the Ten Commandments, see J.P. Chrétien, Les medias du genocide.  Return

     33) ICTR, Judgement and Sentence: The Prosecutor of the ICTR v. Ferdinand Nahimana, Jean-Bosco Barayagwiza, Hassan Ngeze, ICTR-99-52-T, 3 December 2003.   Return

     34) ICTR, The Prosecutor of the ICTR v. Hassan Ngeze, Amended Indictment, ICTR-97-27-I, para. 5.6.   Return

     35) Colette Braeckman, Les nouveaux prédateurs. Politique des puissances en Afrique centrale, Fayard, 2003, p. 163.   Return

     36) HRW/FIDH, op. cit., note 30, p. 215.   Return

     37) The October 1998 ICTR judgment (ICTR-1996-4) of Jean-Paul Akayesu former prefect of Taba, is an eloquent example.   Return

     38) Telephone interview carried out on March 17 in Nyanza.   Return

     39) UNAIDS/UNICEF/WHO, Rwanda. Epidemiological Fact Sheets on HIV/AIDS and SexuallyTtransmitted Infections, 2002.   Return

     40) AVEGA-AGOHOZO, op. cit., note 4.   Return

     41) Save the Children, op. cit., note 5.   Return

     42) National AIDS Control Commission (NACC), op. cit., pp 25 and 37.   Return

     43) Ibid., p. 22.   Return

     44) Martine David, Gender Relations and AIDS, International Cooperation Center for Health and Development, June 1997.   Return

     45) See Appendix: Testimony of women who were victims or rape and HIV/AIDS during the Rwandan genocide   Return

     46) Not to be confused with the Duhozanye Association of Butare, which also brings together genocide survivors.   Return

     47) Interviews, February 17, 2004 , Cyangugu.   Return

     48) Amnesty International, op. cit., note 19.   Return

     49) UNAIDS/UNICEF/WHO, op. cit., note 39.   Return

     50) AVEGA-AGAHOZO, Rapport d'utilisation du fonds de soutien aux femmes victims des violences, September 21, 2002 to June 21, 2003.   Return

     51) Colette Braekman , Rwanda. Histoire d'un genocide, Fayard , 1994, p. 97.   Return

     52) Interviews, Polyclinic of Hope, Kagugu, February 13, 2004.   Return

     53) Françoise Ngendahayo, “Gender and HIV/AIDS challenges,” Paper presented at the Expert Group Meeting on the HIV/AIDS Pandemic and its Gender Implications, 13-17 November 2000.   Return

     54)Ubutabera, No. 29, December 9, 1997.   Return

     55) ICTR, Press Release: ICTR Launches Victim Support Initiative In Rwanda , ICTR/INFO-9-2-242, 26 September 2000.   Return

     56) International Crisis Group, “International Criminal Tribunal for Rwanda: Justice Delayed,” Africa Report, no. 30, June 7, 2001, p. 37.   Return

     57) Letter appended to ICTR/INFO-9-12-017, October 9, 2000.   Return

     58) Ibid.   Return

     59) International Crisis Group, op. cit., note 58.   Return

     60) These infections arise when the body's immune system is weak.   Return

     61) Jean-Maurice Arbour, Droit international public, 4th edition, Cowansville, QC, Yvon Blais, 2002, p. 507.   Return

     62)Case Concerning the Factory atChorzow (Claim for Indemnity), P.C.I.J., Series A, No. 17, Sept. 13, 1928.   Return

     63)See rule 88 B) and rule 105 of the Rules of Procedure and Evidence.   Return

     64) See revised Basic Principles and Guidelines on the Right to Remedy and Reparation for Victims of Violations of International Human Rights and Humanitarian Law dated 5 August 2004. According to According to point 20, restitution should, as appropriate, include restoration of liberty, legal rights, social status, identity, family life and citizenship, return to one's place of residence and restoration of employment and return of property.   Return

     65) Ibid.   Return

     66) Ibid, point 25. Satisfaction should include, for example, cessation of continuing violations and/or legal or administrative sanctions against the persons responsible for the violations and/or apologies, specifically, public acknowledgement of the facts and acceptance of responsibility and/or commemoration and tributes to the victims.   Return

     67) Ibid, point 26. These are measures taken by national legal systems aimed at preventing a recurrence of violations. For example, measures aimed at ensuring and strengthening, as a priority and on a continuing basis, training in human rights and international humanitarian law to all sectors of society, including training of the staff responsible for applying the relevant legislation, as well as military and security forces.   Return

     68) United Nations, Economic and Social Council, The right to restitution, compensation and rehabilitation for victims of gross violations of human rights and fundamental freedoms, Final report of the Special Rapporteur, Mr. M. Cherif Bassiouni, submitted in accordance with Commission resolution 1999/33, E/CN.4/2000/62, 18 January 2000, point 24.   Return

     69)United Nations, Economic and Social Council, The right to a remedy and reparation for victims of violations of international human rights and humanitarian law, Note by the High Commissioner for Human Rights , E/CN.4/2003/63, 27 December 2002, point 57.   Return

     70) Our emphasis.   Return

     71) Our emphasis.   Return

     72) ICTR, Victims and Witnesses Support Unit, Manual of Operational Guidance.  Return

     73) Ibid.   Return

     74) Ibid., p. 51.   Return

     75) ICTR, Press Briefing by the Spokesman for theICTR, ICTR/INFO-9-13-016, 19 September 2000.   Return

     76) Our emphasis. United Nations, General Assembly, Security Council, Report of the International Criminal Tribunal for the Prosecution of Persons Responsible for Genocide and Other Serious Violations of International Humanitarian Law Committed in the Territory of Rwanda and Rwandan Citizens Accused of Genocide and Other Such Violations Committed in the Territory of Neighbouring States between 1 January and 31 December 1994, A/57/163-S/2002/733, 2 July 2002, point 89.   Return

     77) In its Resolution 1503 (2003), the Security Council requested the ICTR to complete its investigations by the end of 2004, hold all trials at first instance by the end of 2008, and terminate its work in 2010.   Return

     78) ICTR, Manual of Operational Guidance, op cit., note 72.   Return

     79) Ibid.   Return

     80) United Nations, Economic and Social Council, op. cit., note 69, p. 9.   Return

     81) United Nations, General Assembly, Security Council, Report of the International Criminal Tribunal for the Prosecution of Persons Responsible for Genocide and Other Serious Violations of International Humanitarian Law Committed in the Territory of Rwanda and Rwandan Citizens Responsible for Genocide and Other Such Violations Committed in the Territory of Neighbouring States between 1 January and 31 December 1994 , A/59/183-S/2004/601, June 2004, point 60.   Return

     82) Our emphasis.   Return

     83) United Nations, General Assembly, Security Council, op. cit., note 64, points 90-91.   Return

     84) Op. cit., note 64, see Preamble.   Return

     85) United Nations, General Assembly, Security Council, Report of the International Criminal Tribunal for the Prosecution of Persons Responsible for Genocide and Other Serious Violations of International Humanitarian Law Committed in the Territory of Rwanda and Rwandan Citizens Responsible for Genocide and Other Such Violations Committed in the Territory of Neighbouring States between 1 January and 31 December 1994, A/58/140-S/2003/707, 11 July 2003, point 71-72.   Return

     86) ICTR, Press Release, The President of the UN Human Rights Commission to Lead a Campaign to Support Victims,ICTR/INFO-9-2-363, October 7, 2003 .   Return

     87) ICG, op. cit., note 56, pp. 37 to 41.   Return

     88) ICTR, Press Release, ICTR Registrar Seeks Support of the African Community, ICTR/INFO-9-2-343.EN, 9 May 2003.   Return

     89) United Nations, Economic and Social Council, op. cit., note 68.   Return

     90) Ibid, p. 39.   Return

     91) Rule 106 of the Rules of Procedure and Evidence reads as follows:
(A) The Registrar shall transmit to the competent authorities of the States concerned the judgement finding the accused guilty of a crime which has caused injury to a victim.
(B) Pursuant to the relevant national legislation, a victim or persons claiming through him may bring an action in a national court or other competent body to obtain compensation.
(C) For the purposes of a claim made under Sub-Rule (B) the judgement of the Tribunal shall be final and binding as to the criminal responsibility of the convicted person for such injury.   Return

     92) ICTR, Witnesses and Victims Unit, op. cit., note 72, p. 41.   Return

     93) National AIDS Control Policy, op. cit., note 20, pp. 68-69.   Return

     94) Ibid., pp. 22-24.   Return

     95) Ibid., p. 53.   Return

     96) Ibid., pp. 69-70.   Return

     97) Interviews with Jean Gatana, National AIDS Control Commission, Kigali, February 13, 2004.   Return

     98) UNDP Human Development Report 2002, p. 205.   Return

     99) Interviews conducted in Taba on February 16, 2004.   Return

     100) Interviews conducted in Kigali on February 12, 2004.   Return

     101) Interviews conducted in Kigali, February 12, 2004.   Return

     102) Interviews conducted in Cyangugu on February 17, 2004.   Return

     103)National AIDS Control Policy, op. cit., note 20, p. 55.   Return

     104) Ibid., p.104.   Return

     105) Ibid..   Return

     106) Ibid., p. 105.   Return

     107) Ibid., p. 106.   Return

     108) Ibid., pp. 108-109.   Return

     109)Guide d'utilisation des médicaments antirétroviraux chez l'adulte and l'enfant [antiretroviral drug use guide for adults and children] , Ministry of Health, Treatment and Research on AIDS Centre, 2003.   Return

     110) Ibid.   Return

     111) Ibid., emphasis ours.   Return

     112) National AIDS Control Policy, op. cit., note 20, p. 27.   Return

     113) AVEGA-AGAHOZO, op cit., note 4, pp. 41-42.   Return

     114) Médecins sans Frontières, Belgium, Rwanda Activity Report 2003, p. 6.   Return

     115) Interviews granted on February 12, 2004, in the Kimironko health centre.   Return

     116) The international NGOs working in Rwanda and humanitarian organizations such as the International Committee of the Red Cross (ICRC), Doctors Without Borders and Médecins du Monde should be added to the list of donors mentioned in earlier.   Return

     117) The mandate of the Coalition for Women's Human Rights in Conflict Situations, coordinated by Rights & Democracy, is to ensure that crimes committed against women in conflict situations are adequately examined and prosecuted. The Coalition seeks solutions to the invisibility of women's human rights abuses in conflict situations, to condemn the practice of sexual violence and other inhumane treatment of women as deliberate instruments of war, and to ensure that these are prosecuted as war crimes, torture, crimes against humanity, and crimes of genocide, where appropriate. Working at the local and international levels, Coalition members act as a resource for consultation and debate on substantive issues related to the integration of a gender perspective in post-conflict transitional justice systems. Coalition efforts also seek to strengthen international and regional capacity to monitor the respect of women's human rights in conflict and post-war situations through the creation of appropriate mechanisms of accountability and the assessment of their transferability to other contexts. The main focus of the Coalition's work is to promote the adequate prosecution of perpetrators of crimes of gender violence in transitional justice systems based in Africa, in order to create precedents that recognise violence against women in conflict situations and help find ways to obtain justice for women survivors of sexual violence.   Return

     118)AVEGA-AGAHOZO, op. cit., note 4, p. 56.  Return